Three-dimensional CT volumetry predicts outcome of laparoscopic splenectomy for splenomegaly: retrospective clinical study.
BACKGROUND
The aim of this study was to determine the predictive value of the preoperative three-dimensional reconstructed volume (3D volumetry) for outcomes of laparoscopic splenectomy. The impact of splenomegaly on the feasibility of laparoscopic splenectomy is still debated. We hypothesized that splenic volumetry may accurately estimate splenic volume preoperatively and be used by surgeons to select patients for laparoscopic splenectomy.


METHODS
We performed a retrospective review of 88 patients seen at a tertiary referral center undergoing laparoscopic or open splenectomy between 2001 and 2010. Patients included in the study underwent elective splenectomy without associated procedures and had preoperative imaging available at our institution. We evaluated clinical, demographic characteristics and perioperative imaging as predictors of outcome. Study endpoints included conversion to open splenectomy, operating time, estimated blood loss (EBL), length of stay (LOS), postoperative complications, and mortality.


RESULTS
In all, 53 procedures were started laparoscopically. Among them, 7 (13.2 %) were converted to open splenectomy and 7 (13.2 %) to hand-assisted laparoscopic splenectomy. The conversion group was matched with 35 patients who underwent open splenectomy to determine differences in outcomes between these groups. There were no conversions in spleens measuring <1100 cc, whereas spleens of 1100 to 2700 cc had a conversion rate of 41 %. Spleen volume >2700 cc was associated with an 87.5 % conversion rate. Spleen 3D volumetry >2700 cc was the only independent predictor of surgical conversion on multivariate analysis (odds ratio 38.0, confidence interval 4.02-358.75, p = 0.001). Patients who underwent open splenectomy had shorter operating times (160.3 vs. 253.0 min, p = 0.001) than those converted from laparoscopic to open splenectomy.


CONCLUSIONS
A 3D reconstructed splenic volume of >2700 cc is a predictor of conversion from laparoscopic to open splenectomy. For spleens measuring <2700 cc, laparoscopic splenectomy may be performed by experienced surgeons with low to moderate rates of conversion. For spleens with a 3D reconstructed volume >2700 cc, laparoscopic splenectomy is associated with high rates of conversion to open surgery.
Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA. filippo.filicori@gmail.com
Filippo
F
Filicori
Cameron
C
Stock
Andrew D
AD
Schweitzer
Xavier M
XM
Keutgen
Maria D
MD
Lagratta
Rasa
R
Zarnegar
Thomas J
TJ
Fahey
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054893:Cone-Beam Computed Tomography / Q000379:methods; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013163:Splenomegaly / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult