Elective splenectomy in patients with non-Hodgkin lymphoma: Does the size of the spleen affect surgical outcomes?

Abstract

BACKGROUNDS/AIMS: Splenectomy in patients with non-Hodgkin lymphoma (NHL) is performed to relieve abdominal symptoms, treat hypersplenism or confirm diagnosis. Excision of a very large spleen is technically challenging and data on outcomes of surgery in patients with NHL are scanty. The aim of study was to evaluate the impact of spleen size on the surgical outcome of splenectomy in patients with NHL. METHODS: Patients with NHL who underwent splenectomy, between 2006 and 2017, were included and divided into two groups: group 1, spleen ≤ 20 cm; group 2, spleen > 20 cm. Surgical approach, operative time, postoperative morbidity, mortality, hospital stay and re-admission rates were retrospectively compared between groups. Non-parametric data were evaluated with the Mann-Whitney U test. Differences in frequencies were analyzed with Fisher's exact test. RESULTS: Sixteen patients were included (group 1, 6; group 2, 10). Laparoscopy was successful in three patients of group 1, none of group 2 (p = 0.035), the intraoperative time did not differ significantly between groups. One patient in each group developed postoperative complications. The patient in group 1 died of pneumonia. Median length of stay was 8 days (range, 3-16 days) for group 1, 5.5 days (range, 3-10 days) for group 2, showing no significant difference between the two groups. No patient was readmitted to hospital. CONCLUSIONS: Spleen size does not affect the outcome of splenectomy in patients with NHL. If a mini-invasive approach is to be chosen, laparoscopy may not be feasible when the spleen size is > 20 cm.