Splenectomy and cancer

ALSO KNOWN AS: Spleen removal

DEFINITION: A splenectomy is the surgical removal of the spleen, which is located in the upper left portion of the abdominal cavity. The spleen filters the blood, removing old or damaged blood cells from circulation and eliminating bacteria, parasites, and other organisms that can cause infection. It also produces and stores blood.

Cancers diagnosed or treated:Hodgkin's disease (staging), non-Hodgkin's lymphoma, chronic myelogenous leukemia, chronic B-cell leukemias (hairy cell and prolymphocytic leukemia)

Why performed: A splenectomy is most commonly performed on a ruptured spleen, which, if not immediately treated, can cause life-threatening bleeding into the abdominal cavity. Splenectomies are also performed in patients with Hodgkin's disease for staging the extent of disease; with non-Hodgkin's lymphoma, leukemias, and splenomegaly for symptom control; or for correction of cytopenias (low blood cell counts) in patients with immune-mediated destruction of one or more blood elements.

Patient preparation: A few days before the procedure, blood and urine tests and X-rays of the abdomen are performed. Immunizations against pneumococcal infections and meningococcal infections are administered, preferably a couple of weeks before the procedure (frequently, this is not possible, particularly in the case of a ruptured spleen due to trauma or injury). If blood counts (red blood cells or platelets) are low, a transfusion may be necessary before the procedure can be performed.

Steps of the procedure: A splenectomy may be performed by the classic, open method or by laparoscopy. Before the procedure, anesthesia is administered, and an airway tube is placed in the windpipe.

In the classic surgery method, one incision is made in the abdomen over the spleen, and the blood vessels to and around the spleen are cut and tied off. This detaches the spleen from the rest of the body, and no further exchange of blood between the spleen and the rest of the body can occur. The spleen is then removed. If bleeding occurs, it may be controlled with a cautery, which burns the tissue, or by tying the blood vessels. The incision is cleaned and closed with stitches or staples, which are generally removed approximately one week after surgery.

During a laparoscopy, three to four small incisions are made in the abdomen. A laparoscope (a lighted tube with a small camera that projects a view of the internal structures to a video monitor) is inserted through one of these incisions. Specialized instruments are inserted through the two to three additional incisions for the doctor to perform the procedure. To provide more room for the doctor to work, carbon dioxide gas is pumped into the abdomen to inflate the abdomen. As with the classic surgery, blood vessels to the spleen are cut and tied off, and the spleen is removed. The incisions are closed with stitches and covered with surgical tape.

After the procedure: Blood tests and a pathology exam of the removed spleen may be performed. If necessary, a blood transfusion may be administered.

Risks: Factors that may increase the risk for complications during the procedure include obesity, smoking, poor nutrition, recent or chronic illness, diabetes, advanced age, or a preexisting heart or lung disease. Complications that may be associated with a splenectomy include an increased risk for infection and, though rare, injury to surrounding organs (pancreas, stomach, or colon). Possible complications of any surgery include infection and excess bleeding. Additional complications that may occur with any surgery involving anesthesia include a collapsed lung, deep-vein blood clots, or thromboembolism (blockage of a blood vessel caused by a blood clot), especially in older adults.

Research and studies in the 2020s have altered the medical community’s view on the effectiveness of splenectomy in relation to cancer treatment. The results of a study released in 2024 showed that while splenectomy was effective in treating primary tumors, it may increase the rate of cancer metastases throughout the body. These results suggest that more studies are needed to understand the types and stages of cancer for which splenectomy is more appropriate. Studies have also indicated differing effects of splenectomy on immune system response; in some cases, the splenectomy increasing the body’s immune response, and, in other cases, decreasing it. Another study indicated doctors are increasingly using splenectomy in ovarian cancer cases to improve outcomes and enhance longevity. Finally, doctors continue to refine the surgical techniques used in splenectomy.

Results: Recovery time can vary depending on the underlying disease or condition. In general, however, complete healing from the procedure occurs in about four to six weeks. The results of splenectomy also vary according to the reason for the procedure:

• Ruptured spleen: Once a ruptured spleen is removed, the risk of life-threatening bleeding is eliminated.
• Splenomegaly: Pain and discomfort are effectively reduced if the patient was experiencing symptoms attributable to splenomegaly.
• Chronic myelogenous leukemia: A splenectomy significantly improves symptoms and simplifies management (by reducing transfusion requirements) in patients with chronic myelogenous leukemia.
• Chronic leukemia: A splenectomy may also be an effective secondary treatment for hairy cell leukemia and prolymphocytic leukemia, significantly reducing the tumor.
• Cytopenias: Splenectomy has been shown to correct cytopenias in many patients with immune-mediated destruction of one or more cellular blood elements.

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