Influence of splenectomy on perioperative morbidity and long-term survival after esophagectomy in patients with esophageal carcinoma.
The aim of this study was to determine the influence of splenectomy on perioperative morbidity and mortality, as well as on the long-term survival after esophageal resection for carcinoma of the esophagus. From September 1985 to July 2003, 404 patients underwent surgery for esophageal carcinoma in our institution. Splenectomy was performed in 34 (8.4%) patients. Perioperative morbidity and long-term survival were compared in patients with and without concomitant splenectomy. Splenectomy was associated with an increase in intraoperative blood loss and the need for transfusions of blood preserves (P < 0.0001). However, there were no significant differences in pulmonary, general, or surgical complications between patients with and without (P > 0.05) splenectomy. While the survival rate of 13.9 months recorded in patients without splenectomy was longer compared with a survival rate of 8.9 months for patients after splenectomy, it did not reach statistical significance (P = 0.315). The analysis of survival time (log-rank) did not yield any differences between squamous cell and adenocarcinoma, distal tumor location and adenocarcinoma in combination with distal location for patients with and without concomitant splenectomy (P > 0.05). Incidental splenectomy in esophageal resection for esophageal carcinoma is not associated with an increase in perioperative morbidity. Both effective intraoperative management and postoperative intensive care therapy are essential measures in the avoidance of fatal complications after splenectomy. Although it is not yet proven, that splenectomy may have an adverse effect on long-term prognosis, operative procedure should avoid removing the spleen.
Gockel
I
I
Department of General and Abdominal Surgery, Johannes Gutenberg University, Mainz, Germany. gockel@ach.klinik.uni-mainz.de
Kneist
W
W
Junginger
T
T
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013156:Splenectomy; D016019:Survival Analysis