Open splenectomy: ten-year experience in an oncological referral center

Open splenectomy is a useful procedure for some diseases with splenomegaly >1500 g. We undertook this study to evaluate open splenectomy morbidity and mortality at the Instituto Nacional de Cancerologia in Mexico City. We reviewed the clinical files of patients with benign and malignant hematological diseases, as well as other diseases, who underwent splenectomy from 1994 to 2005. Twenty five patients with a mean age of 38.5 years were submitted for open splenectomy. Splenomegaly was found in 12 patients (48%). The most frequent abdominal wall incision was transverse left subcostal (64%). Average surgical time was 125 min, bleeding 485 ml, spleen weight 1553.6 g and mean size 15 x 11 x 12 cm. Mean hospital stay was 7.5 days. Eighteen patients (72%) did not have immediate complications. One patient (4%) developed surgical wound infection, two patients (8%) had significant pain, three patients (12%) had bleeding and one patient (4%) developed intraabdominal fluid collection. Twenty one patients (84%) did not have further complications. One patient (4%) developed multiple organ failure, another patient (4%) developed thrombocytopenia and another (4%) developed severe pain. During an average 81-month follow-up we found 14 patients (56%) asymptomatic, two patients (8%) with documented tumoral activity (angiosarcoma and non-Hodgkin's lymphoma) and one patient (4%) developed a second neoplasm. Six patients (24%) died due to underlying disease (chronic myeloid leukemia and lymphoma), one patient (4%) with active disease (Hodgkin's disease) and one patient (4%) died due to other causes. With a spleen >1500 g, open surgery offers better visibility and, in fact, less morbidity and mortality.