title: Unplanned splenectomy during oesophagectomy does not affect survival.
abstract: OBJECTIVE
  There are limited and conflicting data available concerning the incidence of inadvertent splenectomy and its impact on the outcome in patients who have undergone oesophagectomy. The aim of this study is to identify the factors associated with a likelihood of inadvertent splenectomy and its influence on early and long-term outcome in patients having oesophagectomy for oesophageal carcinoma.
  
  
  METHODS
  A consecutive series of 738 oesophagectomies performed between 1991 and 2004 was analysed. In our practice, the spleen was removed only if damaged intraoperatively. Routine chemo- and immunoprophylaxis would subsequently be used. Multivariate analysis with logistic and Cox models determined significant variables.
  
  
  RESULTS
  Of the 738 oesophagectomies, 48 (6.5%) had splenectomy. Neoadjuvant chemotherapy was administered to a minority of patients; none subsequently had splenectomy. There were significant differences between types of operation (Ivor-Lewis 18 (9.0%), left thoracolaparotomy 14 (9.9%) and left thoracophrenotomy 15 (3.9%), p=0.01). Splenectomy was more common with advanced N stage disease (OR=0.44 [0.20-0.95]; p=0.04). Splenectomy resulted in more blood transfusions (median, 2 units vs 0 units; p=0.03) more anastomotic leaks (7 [14.6%] vs 42 [6.1%]; p=0.02) but not an increase in pulmonary complications (p=0.64) or in-hospital mortality (1 [4.6%] vs 37 [5.4%]; p=0.30). Splenectomy did not significantly affect median survival (551 [332-770] days vs 627 [554-700] days; p=0.63).
  
  
  CONCLUSIONS
  Although inadvertent splenectomy increased the morbidity of oesophagectomy, it did not impair survival. Type of operation and advanced N stage are important risks for splenectomy. Though best avoided, most of the consequences of splenectomy can be managed. An unexpected relationship between splenectomy and anastomotic leaks needs further investigation.
authors.affiliation: Department of Thoracic Surgery, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom. edblackis@hotmail.com
authors.forename: Edward
authors.initials: E
authors.lastname: Black
authors.forename: Jason
authors.initials: J
authors.lastname: Niamat
authors.forename: Srikanth
authors.initials: S
authors.lastname: Boddu
authors.forename: Antonio
authors.initials: A
authors.lastname: Martin-Ucar
authors.forename: John P
authors.initials: JP
authors.lastname: Duffy
authors.forename: William Ellis
authors.initials: WE
authors.lastname: Morgan
authors.forename: Francis David
authors.initials: FD
authors.lastname: Beggs
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010404:Penicillin V / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013156:Splenectomy / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D010406:Penicillins; D010404:Penicillin V