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Effect of Iatrogenic Spleen Injuries During Colorectal Carcinoma Surgery on the Early Postoperative Result
Meyer Frank*1,5, Rene Mettke2,5, a. Schmidt3,5, Stefanie Wolff1,5, Andreas Koch4,5, Henry Ptok2,5, Hans Lippert1,5, Ingo Gastinger5
1Dept. of General, Abdominal & Vascular Surgery, University Hospital, Magdeburg, Germany; 2Dept. of Surgery, Municipal Hospital, Cottbus, Germany; 3Oncological Practice, Municipal Health Care, Cottbus, Germany; 4Surgical Practice, Municipal Health Care, Cottbus, Germany; 5Institute for Quality Assurance in Operative Medicine, University Hospital, Magdeburg, Germany
Introduction: Unlike in gastric carcinomas, the consequences of a spleen injury during operative treatment of the colorectal carcinoma are hardly investigated, as a splenectomy is not performed on these tumour patients to extend the radicality. In this context, the only interest is in the iatrogenic intraoperative spleen lesions, which make a splenectomy necessary or require reconstructive spleen preservation.
Methods: During the study period 01/01/2000 - 12/31/2004, the perioperative data of a prospective multi-center observational study of 46,682 patients whose tumour had been removed with a curative or palliative intention were analysed with respect to the early postoperative consequences of an iatrogenic spleen lesion.
Results: Of these 46,682 patients, 640 patients (1.4%) suffered an iatrogenic spleen injury during the operative therapy. The spleens of 127 patients (0.3%) were removed, the spleens of 513 patients (1.1%) were able to be left in situ following repair. In more than 80% of the cases with an iatrogenic spleen injury, the tumour was localised in the left colon and in the rectum. In the logistic regression, the decisive risk factor for this organ lesion was the mobilisation of the left colonic flexure on tumour localisation in the left colon and rectum. Following a spleen lesion, compared to the patients without spleen injury (36.5%), a significantly higher morbidity rate was registered (47.2% following splenectomy; 48.5% following spleen repair). Anastomotic leaks requiring operation were most frequently observed following a splenectomy (7.9%). This rate was significantly lower following spleen preservation with 3.3% (p=0.003). The total hospital mortality was 3.1%. In patients with splenectomy the hospital mortality was 11.8% and following repair with organ preservation was 4.7% (p<0.0001).
Conclusion: Iatrogenic spleen lesion during colorectal carcinoma surgery represents a significant risk factor for a poorer early postoperative result. In particular, this concerns the high rate of anastomotic leaks and infectious - septic complications. This also affects the rate of higher total morbidity and hospital mortality. By comparison, a significantly worse postoperative result is found in the group of splenectomised patients compared to the group with organ preservation through repair of the injured spleen.
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