Long-term outcomes of a 5-year follow up of patients with immune thrombocytopenic purpura after splenectomy

한재준,Sun Kyung Baek,김시영,조경삼,윤휘중,이재진 대한혈액학회 2010 Blood Research Vol.45 No.3

Background The long-term outcomes of adult patients with immune thrombocytopenic purpura (ITP) after splenectomy are not clear. Methods We retrospectively analyzed 31 patients who underwent splenectomy after diagnosis of ITP at our institution between 1990 and 2009. Long-term follow-up was defined as a follow-up that lasted 1 year or more from splenectomy to the last follow-up. Results The overall response rate to splenectomy was 84%. However, the response rate at 6 and 12 months decreased to 77% and 68%, respectively. During the 6 years of median follow-up after splenectomy, 11 patients (35%) relapsed. The long-term response rate was 55%. The long-term follow-up of 26 patients after responding to splenectomy showed that the median time from splenectomy to relapse was 19 months in the partial response (PR) group; however, there was no relapse after 9 months in the complete response (CR) group. Variables, including age, were not predictive of the long-term response after splenectomy. Additional treatment in patients who did not respond or relapsed after splenectomy was mostly effective. After a median follow-up of 7 years (range: 1-25 years) from the diagnosis, there were 2 deaths, including one due to spontaneous bleeding after repair of duodenal ulcer perforation. Conclusion Although splenectomy is safe and effective, the response rate after splenectomy continuously decreases over time. The duration of response is different between the patients that achieved CR and those that achieved PR. Factors, including age, were not predictors of a response to splenectomy.

Disadvantages of Complete No. 10 Lymph Node Dissection in Gastric Cancer and the Possibility of Spleen-Preserving Dissection: Review

Tetsuro Toriumi,Masanori Terashima 대한위암학회 2020 Journal of gastric cancer Vol. No.

Splenic hilar lymph node dissection has been the standard treatment for advanced proximal gastric cancer. Splenectomy is typically performed as part of this procedure. However, splenectomy has some disadvantages, such as increased risk of postoperative complications, especially pancreatic fistula. Moreover, patients who underwent splenectomy are vulnerable to potentially fatal infection caused by encapsulated bacteria. Furthermore, several studies have shown an association of splenectomy with cancer development and increased risk of thromboembolic events. Therefore, splenectomy should be avoided if it does not confer a distinct oncological advantage. Most studies that compared patients who underwent splenectomy and those who did not failed to demonstrate the efficacy of splenectomy. Based on the results of a randomized controlled trial conducted in Japan, prophylactic dissection with splenectomy is no longer recommended in patients with gastric cancer with no invasion of the greater curvature. However, patients with greater curvature invasion or those with remnant gastric cancer still need to undergo splenectomy to facilitate splenic hilar node dissection. Spleen-preserving splenic hilar node dissection is a new procedure that may help delink splenic hilar node dissection and splenectomy. In this review, we examine the evidence pertaining to the efficacy and disadvantages of splenectomy. We discuss the possibility of spleen-preserving surgery for prophylactic splenic hilar node dissection to overcome the disadvantages of splenectomy.

Disadvantages of Complete No. 10 Lymph Node Dissection in Gastric Cancer and the Possibility of Spleen-Preserving Dissection: Review

Toriumi, Tetsuro,Terashima, Masanori The Korean Gastric Cancer Association 2020 Journal of gastric cancer Vol. No.

Splenic hilar lymph node dissection has been the standard treatment for advanced proximal gastric cancer. Splenectomy is typically performed as part of this procedure. However, splenectomy has some disadvantages, such as increased risk of postoperative complications, especially pancreatic fistula. Moreover, patients who underwent splenectomy are vulnerable to potentially fatal infection caused by encapsulated bacteria. Furthermore, several studies have shown an association of splenectomy with cancer development and increased risk of thromboembolic events. Therefore, splenectomy should be avoided if it does not confer a distinct oncological advantage. Most studies that compared patients who underwent splenectomy and those who did not failed to demonstrate the efficacy of splenectomy. Based on the results of a randomized controlled trial conducted in Japan, prophylactic dissection with splenectomy is no longer recommended in patients with gastric cancer with no invasion of the greater curvature. However, patients with greater curvature invasion or those with remnant gastric cancer still need to undergo splenectomy to facilitate splenic hilar node dissection. Spleen-preserving splenic hilar node dissection is a new procedure that may help delink splenic hilar node dissection and splenectomy. In this review, we examine the evidence pertaining to the efficacy and disadvantages of splenectomy. We discuss the possibility of spleen-preserving surgery for prophylactic splenic hilar node dissection to overcome the disadvantages of splenectomy.

Clinical significance of single-port laparoscopic splenectomy

Eui Soo Han,Young Kyoung You,Dong Goo Kim,Jun Suh Lee,Eun Young Kim,Soo Ho Lee,Tae Ho Hong,Gun Hyung Na 대한외과학회 2015 Annals of Surgical Treatment and Research(ASRT) Vol.89 No.2

Purpose: Single-port laparoscopic splenectomy has been performed sporadically. The aim of this study is to assess our experience with single-port laparoscopic splenectomy compared to conventional multiport laparoscopic surgery for the usual treatment modality for various kinds of splenic disease. Methods: Between October 2008 to February 2014, 29 patients underwent single-port laparoscopic splenectomy and 32 patients received multiport laparoscopic splenectomy. We retrospectively analyzed the clinical outcomes of single-port group and multiport group. Results: The body mass index and disease profiles of the both groups were similar. The operative times of single-port and multiport group were 113.6 ± 39.9 and 95.9 ± 38.9 minutes, respectively (P = 0.946). The operative blood loss of the two groups were 295.8 ± 301.3 and 322.5 ± 254.5 mL (P = 0.582). Postoperative retrieved splenic weight of the single-port and multiport groups were 283.9 ± 300.7 and 362.3 ± 471.8 g, respectively (P = 0.261). One single-port partial splenectomy and 6 multiport partial splenectomies were performed in this study. There was one intraoperative gastric wall injury. It occurred in single-port group, which was successfully managed during the operation. Each case was converted to laparotomy in both groups due to bleeding. There was one mortality case in the multiport laparoscopic splenectomy group, which was not related to the splenectomy. Mean hospital stay of the single-port and multiport group was 5.8 ± 2.5 and 7.3 ± 5.2 days respectively (P = 0.140). Conclusion: Single-port laparoscopic splenectomy seems to be a feasible approach for various kinds of splenic disease compared to multiport laparoscopic surgery.

Splenectomy with endotherapy in non-cirrhotic portal fibrosis related portal hypertension: Can it be an alternative to proximal spleno-renal shunt?

Sundeep Singh Saluja,Ajay Kumar,Hari Govind,Vaibhav Kumar Varshney,Rahul Khullar,Pramod Kumar Mishra 한국간담췌외과학회 2020 Annals of hepato-biliary-pancreatic surgery Vol.24 No.2

Backgrounds/Aims: Proximal splenorenal shunt (PSRS) is usually done in symptomatic non-cirrhotic portal fibrosis (NCPF). The outcomes of splenectomy with endotherapy in non-bleeder NCPF patients has not been well studied. We here by aimed to study the post-surgical outcomes on short and long-term basis between PSRS and splenectomy among non-bleeder NCPF patients. Methods: The consecutive non-bleeder NCPF patients whom underwent either splenectomy or PSRS from 2008 to 2016 were enrolled. The patients were followed up post-surgery clinically and biochemical investigations, Doppler ultrasound and upper gastrointestinal endoscopy were done as required. The peri-operative parameters compared were operative time, blood loss, hospital stay and morbidity. The long-term outcome measures compared were incidence of portal hypertension (PHTN) related bleed, change in grade of varices, shunt patency, shunt complications and thrombosis of spleno-portal axis. Results: Among 40 patients with non-bleeder status, 24 underwent splenectomy and 16 underwent PSRS. The baseline characteristics including indication of surgery, biochemical investigations and grade of varices were comparable between PSRS and splenectomy. The peri-operative morbidity was not significantly different between two groups. The median follow up duration was 42 months (12-72 months), the decrement in grade of varices was significantly higher in PSRS group (p=0.03), symptomatic PHTN related UGIB was non-significant between PSRS and splenectomy (p=0.5). In PSRS group, 3 (18.3%) patients had shunt thrombosis (n=1) & encephalopathy (n=2) while in splenectomy group two patients developed thrombosis of splenoportal axis. Conclusions: Splenectomy with endotherapy is alternative to PSRS in non-bleeder NCPF patients with indications for surgery.

간경화 환자의 간절제시 동반 비장절제술에 의한 간문맥압의 변화

남경희(Kyung Hee Nam),황윤진(Yoon Jin Hwang),천재민(Jae Min Cheon),김상걸(Sang Geol Kim),윤영국(Young Guk Yeun) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.3

Purpose: Concomitant splenectomy in cirrhotic patients is known to ameliorate the tendency to bleed and it decreases the portal venous pressure (PVP). However, the direct measurement of the change in the PVP after concomitant splenectomy has not yet been reported. We tried to measure the change of the PVP before and after splenectomy. Methods: From March 2000 to May 2006, 18 patients underwent anatomical liver resection with concomitant splenectomy. All the patients had liver cirrhosis, thrombocytopenia and/or esophageal varix. Through the 5 French feeding tube, which was inserted into the right gastroepiploic vein after laparotomy, we directly measured the PVP before and after splenectomy, and also under portal triad clamping (PTC). Results: After splenectomy, the PVP decreased significantly from 261.11±45.87 mmH2O to 221.11±38.48 mmH2O (p<0.05). Under PTC, the PVP decreased significantly from 605.00±116.48 mmH2O to 513.89±70.56 mmH2O (p<0.05). Conclusion: Concomitant splenectomy in patients with liver cirrhosis resulted in a significant reduction of the PVP.

면역성 혈소판감소성 자반증 환자의 비장절제술 후 반응 및 수술 전 예후평가 인자

황수현,최용원,민병훈,양지원,박준성 순천향대학교 순천향의학연구소 2015 Journal of Soonchunhyang Medical Science Vol.21 No.2

Objective: Splenectomy has been proposed to be the standard therapy for patients with steroid refractory immune thrombocytopenic purpura (ITP). This study aimed to describe valuable factors predicting the effect of splenectomy in patients with ITP. Methods: A total of 51 adult patients who underwent splenectomy for steroid refractory ITP were evaluated their medical records retrospectively. The response to the treatment was classified on the basis of the platelet count. Results: The responding group included 35 patients (68.8%), the partial-responding group included 4 patients (7.8%), and non-responding group was 12 patients (23.5%). On univariate analysis, the response of splenectomy correlated with only the intravenous immune globulin (IVIG) response (66.7%, P=0.006), but hemolysis, autoantibody, a presence of accessory spleen, the response of steroid were not significantly associated with the effect of splenectomy. On multivariate analysis, the response of IVIG and the amount of platelet transfusion were independent variables of the response of splenectomy. Conclusion: Patients with ITP who have good responses to IVIG are likely to have a good or favorable responses to splenectomy.

소아에서 유전성 구상 적혈구증의 비장 적출술

하정옥,도병수,김창식,서보양,허영수 영남대학교 의과대학 1994 Yeungnam University Journal of Medicine Vol.11 No.1

저자들은 1987년 12월부터 1993년 8월까지 영남대학교 의과대학 부속병원에 입원하여 유전성 구상 적혈구증으로 진단받고 비장적출술을 시행한 9례를 대상으로 임상분석하여 다음과 같은 결론을 얻었다. 1. 총 9명중 남아 5명, 여아 4명으로 남녀비가 비슷하였으며, 6세에서 10세 사이가 9례중 5례로 전체의 반이상을 차지하였다. 2. 가족력을 나타낸 경우는 9례중 4례(44.4%)이었다. 3. 주요임상 증상으로는 빈혈, 황달 및 비장종대가 주증상이었으며, 담석증 및 총담관결석을 동반하였던 2례에서는 우상복부 동통을 나타내었다. 4. 검사실 소견으로는 말초혈액 도말검사상 구상 적혈구를 발견할 수 있었으며, 혈색소 8.1 ±2.4 gm/dl, 헤마토크리트 23.4 ±10.2%, 망상적혈구 15.9 ±11.7%이었으며, 삼투압 취약성은 모두에서 증가되어 있었다. 혈청 전 빌리루빈 8.6 ±10.9 gm/dl, LDH 370.1 ±169.1 IU/L으로 증가되었다. Coombs 검사상 9례 모두 음성반응을 보였다. 5. 9례 모두 비장적출술을 시행하였으며 이들중 담석증을 동반한 1례에서는 담낭절제술, 총담관 결석제거술 및 T-tube 담관조루술을 동시에 시행하였다. 수술 소견상 비장의 무게는 350(150-600)gm이었고, 9례중 3례에서 부비장(accessory spleen)이 관찰되었다. 6. 비장 적출후 유전성 구상 적혈구증 9례에서 수술전 혈색소 8.1 ±2.4 gm/dl, 헤마토크리트 23.4 ±10.2%, 수술후 혈색소 12.3 ±1.2 gm/dl, 헤마토크리트 37.0 ±5.3%로 증가되어 술후 빈혈이 교정되었음을 관찰할 수 있었다. 수술후에 수혈의 필요성은 없었으며, 술후 특별한 합병증없이 9명 모두 현재까지 건강하게 잘 자라고 있다. Among the erythrocyte membrane defects, hereditary spherocytosis is the most common. The erythrocyte membrane defect results from a deficiency of spectrin, the most important structural protein in red cell. Hereditary spherocytosis often presents with hemolytic anemia, jaundice, moderate splenomegaly. Diagnosis is established by the presence of spherocytes in the peripheral blood, reticulocytosis, an increased osmotic fragility, and a negative Coombs test. In children, splenectomy is usually performed after age 6 years but can be done at a younger age if warranted by the severity of the anemia and the need for frequent transfusions. In the period December 1987 to August 1993, 9 patients with hereditary spherocytosis underwent splenectomy and the following results were obtained. 1. Nine patients were comprised of five males and four females. 2. Five patients(55.6%) had been admitted to our hospital during age 6-10 years. 3. Four of the nine patients had autosomal dominant inheritance with variable expression. The other five patients had no known inheritance. 4. The diagnosis of the spherocytosis was based on the increased osmotic fragility and increased autohemolysis of the erythrocytes, as well as on the appearance of spherocytes in the peripheral blood smear. 5. In all cases splenectomy was performed. Two patients had concomitant gall stones and choledocholithiasis, respectively. One patient with concomitant gall stones underwent simultaneous cholecystectomy and splenectomy. The other patient associated with choledocholithiasis underwent splenectomy, cholecystectomy, choledocholithotomy, and T-tube drainage. 6. Complete hematologic recovery was obtained by the splenectomy in all cases. 7. Postoperative complication was not occurred.

A Case of Spontaneous Portal Vein Thrombosis After Splenectomy and its Resolution

장여구,이우용 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.1

Portal vein thrombosis (PVT) is a rare but serious complication of splenectomy that is more common in patients with hematologic disorders (hemolytic anemia, myeloproliferative disease, etc.), but relatively rare when splenectomy is conducted because of trauma. We present the case of a 42-year-old woman, admitted for abdominal trauma, who produced a computed tomography (CT) scan showing a grade IV splenic laceration with perisplenic hematoma and subsequently underwent splenectomy. Preoperatively, a hematologic workup revealed no underlying platelet or coagulation disorder. The patient developed PVT in her anterosuperior branch of the right portal vein and anticoagulation treatment was immediately started. After the event was resolved, no symptoms of PVT were observed, which was confirmed by laboratory and radiologic findings. In summary, we report a case of spontaneous PVT after splenectomy for trauma and its successful resolution with anticoagulation treatment.

비장 손상의 임상적 치료 결과

백승현 ( Seung Hyun Baek ),박성진 ( Sung Jin Park ),김재훈 ( Jae Hoon Kim ),김현성 ( Hyun Seong Kim ),김대환 ( Dae Hwan Kim ),조홍재 ( Hong Jae Jo ),서형일 ( Hyung Il Seo ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.2

Purpose: The management of splenic injuries has shifted from a splenectomy to splenic preservation owing to immunity. The purpose of this study was to assess the kinds of management and outcomes through a review of our experience with splenic injuries. Methods: We retrospectively reviewed 47 patients with traumatic splenic injuries using by electronic medical records from Jan. 2007 and Dec. 2011. Splenic injuries were classified according to the American Association for the Surgery of Trauma (AAST) grading system. Results: There were 11 falls, 11 traffic accidents, 10 motorcylcle accidents, 10 pedestrian accidents and 5 abdominal blunt traumas. Low-grade injured patients (≤Grade Ⅲ) were 29 of 43(61.7%), and High-grade injured patients (≥Grade IV) were 18 of 43(38.3%). In 34 patients, non-surgical treatment was performed, and 14 patients underwent a splenectomy. There were relatively more high-grade in older patients, and the highgrade-injury group showed need for a transfusion (p=0.002), more need for a splenectomy (p<0.001), a longer mean hospital stay (p=0.036), a longer ICU stay (p=0.045) and more combined organ injury (p=0.036). Conclusion: Conservative treatment should be considered in low-grade-injury patients (≤Grade Ⅲ). A Splenectomy was performed on 56% of the patients with Grade Ⅳ injuries, so a splenectomy should be considered carefully in such patients. In patients with a grade Ⅴ injury, we think surgical treatment may be needed. (J Korean Soc Traumatol 2012;25:44-48)