title: Laparoscopic and hand-assisted laparoscopic splenectomy for recurrent and persistent ovarian cancer.
abstract: OBJECTIVE
  Prolonged survival in patients with recurrent ovarian cancer isolated to the spleen has been demonstrated after successful splenectomy. The purpose of this study was to report the outcomes of a series of patients who underwent splenectomy for persistent or recurrent ovarian cancer via laparoscopy or hand-assisted laparoscopy.
  
  
  METHODS
  We reviewed the charts of all patients who underwent laparoscopic or hand-assisted laparoscopic splenectomy for presumed persistent or recurrent ovarian cancer. Demographic, clinical, pathologic, and follow-up information was abstracted.
  
  
  RESULTS
  Six patients underwent laparoscopy or hand-assisted laparoscopy for presumed ovarian cancer involving the spleen. In 5 of the 6 cases, laparoscopic or hand-assisted laparoscopic splenectomy was successfully performed. For the 5 laparoscopic cases, operative times varied from 155 to 315 min, and estimated blood loss ranged from 50 to 300 ml. There were no perioperative mortalities or significant complications. Hospitalization lasted from 3 to 5 days. Four patients are alive with no evidence of disease at 2-84 months from the splenectomy, while 1 patient died of disease 20 months after the procedure. The sixth patient underwent initial hand-assisted laparoscopy, and the case was immediately converted to laparotomy for resection of peritoneal carcinomatosis.
  
  
  CONCLUSIONS
  Laparoscopic and hand-assisted laparoscopic splenectomies are safe and feasible in the management of patients with presumed persistent or recurrent ovarian cancer. Larger studies are necessary and eagerly awaited to help determine the long-term risks and benefits as well as the most appropriate candidates and selection criteria.
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, MRI-1026, New York, NY 10021, USA. gynbreast@mskcc.org
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Chi
authors.forename: Nadeem R
authors.initials: NR
authors.lastname: Abu-Rustum
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sonoda
authors.forename: HyunSoon Beatrice
authors.initials: HB
authors.lastname: Im
authors.forename: Namita
authors.initials: N
authors.lastname: Jhamb
authors.forename: Michael
authors.initials: M
authors.lastname: D'Angelica
authors.forename: Mina
authors.initials: M
authors.lastname: Rim
authors.forename: Jakob
authors.initials: J
authors.lastname: Dupont
authors.forename: Richard R
authors.initials: RR
authors.lastname: Barakat
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*; D016896:Treatment Outcome