title: Splenectomy for massive splenomegaly: long-term results and risks for mortality.
abstract: OBJECTIVE
  To evaluate long-term outcomes after splenectomy for massive splenomegaly in a series of 222 consecutive patients.
  
  
  BACKGROUND
  Splenectomy for massive splenomegaly (>1500 g) provides palliation but is associated with a high rate of perioperative complications in a population of patients with advanced hematological malignancies. Predictive factors for survival and whether the palliative goals are achieved in the long-term are not well defined.
  
  
  METHODS
  Patients with various hematological disorders who underwent splenectomy between 1998 and 2009 were followed until death or for at least 2 years. Linear and logistic regression analyses were used to ascertain the impact of demographical factors, diagnoses, and preoperative transfusion parameters on the postoperative survival.
  
  
  RESULTS
  Splenectomy for massive splenomegaly was performed most commonly for non-Hodgkin lymphoma (48%) and myeloid metaplasia (31%). Mean ± standard deviation splenic weight was 2731 ± 1393 g (range, 1500-13,085 g). Average operating time was 115 minutes, with a range from 46 to 346 minutes. Thirty-day mortality was 1.8%, and the complication rate was 20%. The most common complications were hemorrhage (9%) and portal venous thrombosis (9.9%). Relief from pressure-related symptoms was achieved in 98.5%, and durable remission of anemia and thrombocytopenia persisted in half of the patients at 2 years. Sex, age, and intraoperative blood loss were not significantly associated with survival. Preoperative need for red blood cell and platelet transfusions were the most significant risk factors associated with decreased survival.
  
  
  CONCLUSIONS
  Splenectomy for massive splenomegaly can be performed safely and offers durable palliation. Preoperative transfusion requirement is an indicator of hematological disease severity and predictor of decreased survival.
authors.affiliation: *Department of Surgery †Division of Hematology, Department of Internal Medicine ‡Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Timucin
authors.initials: T
authors.lastname: Taner
authors.forename: David M
authors.initials: DM
authors.lastname: Nagorney
authors.forename: Ayalew
authors.initials: A
authors.lastname: Tefferi
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Habermann
authors.forename: William S
authors.initials: WS
authors.lastname: Harmsen
authors.forename: Seth W
authors.initials: SW
authors.lastname: Slettedahl
authors.forename: John H
authors.initials: JH
authors.lastname: Donohue
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D013156:Splenectomy / Q000009:adverse effects* / Q000401:mortality*; D013163:Splenomegaly / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome