title: Iatrogenic splenectomy during nephrectomy for renal tumors.
abstract: OBJECTIVE
  To evaluate risk factors associated with iatrogenic splenectomy during nephrectomy and to assess outcomes among patients undergoing nephrectomy for renal tumors.
  
  
  METHODS
  Of 4323 patients who underwent nephrectomy at Mayo Clinic between 1992 and 2008, 33 (0.8%) had an iatrogenic/unplanned splenectomy. In a case-control study design, controls without splenectomy were matched 1:3 based on age, sex, surgical date, side of the renal tumor, surgical approach and surgeon. Perioperative features and survival were evaluated using conditional logistic and Cox regression.
  
  
  RESULTS
  Among the 33 iatrogenic splenectomy patients, the majority (94%) underwent radical, open and left-sided nephrectomy. Primary tumor classification ≥T3 was the only clinicopathological risk factor significantly associated with splenectomy (odds ratio 3.4; P = 0.02). Compared with controls, patients with an iatrogenic splenectomy were more likely to have longer operative time (205 vs 171 min; P = 0.02), higher estimated blood loss (1.3 vs 0.3 L; P = 0.001), longer length of stay (median 7 vs 5 days; P = 0.03) and a higher likelihood for postoperative complications (odds ratio 5.3; P = 0.002). With a median of 9.8 years of follow up, splenectomy patients tended to have greater all-cause mortality (hazard ratio 1.6; P = 0.07), although this difference approached statistical significance.
  
  
  CONCLUSIONS
  Iatrogenic splenectomy is a rare complication during nephrectomy and is associated with locally advanced tumors (≥pT3). It also carries prognostic significance for adverse perioperative outcomes and possibly diminished survival, although this warrants further study.
authors: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors: Jeffrey K
authors: JK
authors: Wang
authors: Matthew K
authors: MK
authors: Tollefson
authors: Simon P
authors: SP
authors: Kim
authors: Stephen A
authors: SA
authors: Boorjian
authors: Bradley C
authors: BC
authors: Leibovich
authors: Christine M
authors: CM
authors: Lohse
authors: John C
authors: JC
authors: Cheville
authors: R Houston
authors: RH
authors: Thompson
mesh_terms: D000236:Adenoma / Q000401:mortality / Q000601:surgery; D018249:Adenoma, Oxyphilic / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000401:mortality / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D007431:Intraoperative Complications / Q000401:mortality / Q000601:surgery; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data*; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D013156:Splenectomy / Q000401:mortality / Q000706:statistics & numerical data*; D016019:Survival Analysis
keywords: iatrogenic splenectomy; incidental splenectomy; nephrectomy complications