Inadvertent Splenectomy During Resection for Colorectal Cancer Does Not Increase Long-term Mortality in a Propensity Score Model: A Nationwide Cohort Study.
BACKGROUND
Previous studies suggest that long-term mortality is increased in patients who undergo splenectomy during surgery for colorectal cancer. The reason for this association remains unclear.


OBJECTIVE
The purpose of this study was to investigate the association between inadvertent splenectomy attributed to iatrogenic lesion to the spleen during colorectal cancer resections and long-term mortality in a national cohort of unselected patients.


METHODS
This was a retrospective, nationwide cohort study.


METHODS
Data were collected from the database of the Danish Colorectal Cancer Group and merged with data from the National Patient Registry and the National Pathology Databank.


METHODS
Danish patients with colorectal cancer undergoing curatively intended resection between 2001 and 2011 were included in the study.


METHODS
The primary outcome was long-term mortality for patients surviving 30 days after surgery. Secondary outcomes were 30-day mortality and risk factors for inadvertent splenectomy. Multivariable and propensity-score matched Cox regression analyses were used to adjust for potential confounding.


RESULTS
In total, 23,727 patients were included, of which 277 (1.2%) underwent inadvertent splenectomy. There was no association between inadvertent splenectomy and long-term mortality (adjusted HR = 1.15 (95% CI, 0.95-1.40); p = 0.16) in the propensity score-matched model, whereas 30-day mortality was significantly increased (adjusted HR = 2.31 (95% CI, 1.71-3.11); p < 0.001). Inadvertent splenectomy was most often seen during left hemicolectomy (left hemicolectomy vs right hemicolectomy: OR = 24.76 (95% CI, 15.30-40.06); p < 0.001).


CONCLUSIONS
This study was limited by its retrospective study design and lack of detailed information on postoperative complications.


CONCLUSIONS
Inadvertent splenectomy during resection for colorectal cancer does not seem to increase long-term mortality. The previously reported reduced overall survival after inadvertent splenectomy may be explained by excess mortality in the immediate postoperative period.
1 Department of Gastroenterology, Surgical Unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark 2 Department of Surgical Gastroenterology, Copenhagen University Hospital Køge, Køge, Denmark 3 Danish Colorectal Cancer Group, Vejle, Denmark.
Ida
I
Lolle
Hans-Christian
HC
Pommergaard
David F
DF
Schefte
Orhan
O
Bulut
Peter-Martin
PM
Krarup
Steffen J
SJ
Rosenstock
D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D000069451:Long Term Adverse Effects / Q000209:etiology / Q000401:mortality; D008297:Male; D019300:Medical Errors / Q000009:adverse effects / Q000706:statistics & numerical data; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D057216:Propensity Score; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy / Q000706:statistics & numerical data*