Hematolojik hastalıklarda splenektominin mortalite ve morbidite üzerine etkisi

Abstract

Introductıon and Purpose: Splenectomy is an important, yet risky, surgical intervention in patients with certain hematological diseases. Therefore, its benefits should be weighed against potential complications in individual cases. Most of the associated risks seem to be as a result of the underlying hematological disease rather than the procedure itself. In recent years, there is a tendency towards splenic conservation, which has not only decreased the risk of subsequent Overwhelming Post-splenectomy Infections (OPSI) but also long-term cardiovascular morbidity. In this paper, we aim to review the indications and complications of splenectomy procedure in a hematological patient group at our university hospital. Patients and Methods: This study is a descriptive analytical study conducted at the Hematology Outpatient Clinic of Hacettepe University between December 2010 and January 2018. A total of 111 patients who underwent splenectomy were included in the study. Patient demographics, indications for splenectomy, co-morbidities, mortality, and clinical outcome were evaluated. Hematologic diagnostic groups were compared using Fisher‟s exact tests and Wilcoxon rank-sum tests. Results: Of the 111 patients included in the study, 62 (55.9%) were female, and a little over two-thirds (69.4%) were aged 40 years and above. 76 of the participants (68.5%) had therapeutic splenectomy whereas the remainder underwent splenectomy for diagnostic purposes. The complication rate post-spelenctomy was 18.9% (21 patients), and the associated mortality rate was 14.5% (16 patients). Of the 16 mortality cases, 6 occured within 2 months after the procedure, all of which had malignancy. There was a stastistically significant association between early postop mortality (2 months postop) and performance status (as evaluated using ECOG and Karnofski performance scores) as well as Charson comorbidity index. Conclusion: Our study highlighted the safety of splenectomy in most patient groups except for patients with malignancy. The decision to perform splenectomy should, therefore, be based on clinical indications and patient needs taking into consideration alternative strategies reported in ongoing or completed clinical trials.