title: Outcomes following splenectomy in patients with myeloid neoplasms.
abstract: OBJECTIVE
  Myeloid neoplasms are classified into five major categories. These patients may develop splenomegaly and require splenectomy to alleviate mechanical symptoms, to ameliorate transfusion-dependent cytopenias, or to enhance stem cell transplantation. The objective of this study was to determine which clinical variables significantly impacted morbidity, mortality, and survival in patients with myeloid neoplasms undergoing splenectomy, and to determine if operative outcomes have improved over time.
  
  
  METHODS
  The records of all patients with myeloid neoplasms undergoing splenectomy from 1993 to 2010 were retrospectively reviewed.
  
  
  RESULTS
  Eighty-nine patients (n = 89) underwent splenectomy for myeloid neoplasms. Over half of patients who had symptoms preoperatively had resolution of their symptoms post-splenectomy. The morbidity rate was 38%, with the most common complications being bleeding (14%) or infection (20%). Thirty-day mortality rate was 18% and median survival after splenectomy was 278 days. Decreased survival was associated with a diagnosis of myelodysplastic syndrome/myeloproliferative neoplasm, anemia, abnormal white blood cell count, and hypoalbuminemia. Patients who underwent stem cell transplantation did not show an increased risk for morbidity or mortality.
  
  
  CONCLUSIONS
  Patients with myeloid neoplasms have a poor prognosis after splenectomy and the decision to operate is a difficult one, associated with high morbidity and mortality.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Kristy L
authors.initials: KL
authors.lastname: Rialon
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.forename: Eugene P
authors.initials: EP
authors.lastname: Ceppa
authors.forename: Victoria R
authors.initials: VR
authors.lastname: Rendell
authors.forename: Steven N
authors.initials: SN
authors.lastname: Vaslef
authors.forename: Anne
authors.initials: A
authors.lastname: Beaven
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
authors.forename: Dan G
authors.initials: DG
authors.lastname: Blazer
mesh_terms: D000368:Aged; D000740:Anemia / Q000401:mortality; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000401:mortality; D007951:Leukemia, Myeloid / Q000401:mortality* / Q000628:therapy; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality* / Q000628:therapy; D009196:Myeloproliferative Disorders / Q000401:mortality* / Q000628:therapy; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013156:Splenectomy
keywords: acute myeloid leukemia; hypersplenism; myelofibrosis; myeloproliferative neoplasm; splenomegaly