Francois Dagbert1, Remy Thievenaz1, Evelyne Decullier2, Naoual Bakrin1,3, Eddy Cotte1,3, Pascal Rousset4, Delphine Vaudoyer1,3, Guillaume Passot1,3, Olivier Glehen5,6. 1. Department of Digestive and Oncologic Surgery, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon Sud, Pierre-Bénite, France. 2. Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, 69003, France. 3. Unité Mixte de Recherche 3738, Ecole Doctorale EDISS205, Université Claude Bernard Lyon 1, Lyon, France. 4. Department of Radiology, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon Sud, Pierre-Bénite, France. 5. Department of Digestive and Oncologic Surgery, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon Sud, Pierre-Bénite, France. olivier.glehen@chu-lyon.fr. 6. Unité Mixte de Recherche 3738, Ecole Doctorale EDISS205, Université Claude Bernard Lyon 1, Lyon, France. olivier.glehen@chu-lyon.fr.
Abstract
BACKGROUND: Complete cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is increasingly performed on patients with peritoneal carcinomatosis of various origins. Splenectomy often is required in these patients to achieve complete tumor removal. Although splenectomy has been associated with increased morbidity in many major abdominal surgeries, its effect in patients undergoing CRS + HIPEC is unknown. The purpose of this study was to evaluate the impact of splenectomy during CRS + HIPEC on postoperative outcomes. METHODS: We retrospectively identified 39 patients who underwent CRS + HIPEC with splenectomy during a 3-year study period from a prospective database. We compared them to case controls (CRS + HIPEC without splenectomy) that were matched for the complexity of the procedure. We evaluated the complication rate and outcomes of patients in each group. RESULTS: During the study period, splenectomy was performed in 32 % of patients undergoing CRS + HIPEC procedure. Patients in the splenectomy group experienced more grade 3-4 complications than patients in the control group (59 vs. 35.9 %, p = 0.041) as well as more pulmonary complications (41 vs. 7.7 %, p = 0.0006). Multivariate analysis identified splenectomy as the only predictor of overall major complications (odds ratio = 2.57, 95 % confidence interval = 1.03-6.40). Mortality was similar in both groups. CONCLUSIONS: Splenectomy increases major complication rate in patients undergoing CRS + HIPEC and efforts should be made to preserve the spleen during the surgery.
BACKGROUND: Complete cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is increasingly performed on patients with peritoneal carcinomatosis of various origins. Splenectomy often is required in these patients to achieve complete tumor removal. Although splenectomy has been associated with increased morbidity in many major abdominal surgeries, its effect in patients undergoing CRS + HIPEC is unknown. The purpose of this study was to evaluate the impact of splenectomy during CRS + HIPEC on postoperative outcomes. METHODS: We retrospectively identified 39 patients who underwent CRS + HIPEC with splenectomy during a 3-year study period from a prospective database. We compared them to case controls (CRS + HIPEC without splenectomy) that were matched for the complexity of the procedure. We evaluated the complication rate and outcomes of patients in each group. RESULTS: During the study period, splenectomy was performed in 32 % of patients undergoing CRS + HIPEC procedure. Patients in the splenectomy group experienced more grade 3-4 complications than patients in the control group (59 vs. 35.9 %, p = 0.041) as well as more pulmonary complications (41 vs. 7.7 %, p = 0.0006). Multivariate analysis identified splenectomy as the only predictor of overall major complications (odds ratio = 2.57, 95 % confidence interval = 1.03-6.40). Mortality was similar in both groups. CONCLUSIONS: Splenectomy increases major complication rate in patients undergoing CRS + HIPEC and efforts should be made to preserve the spleen during the surgery.