|
|
Back to 2014 Annual Meeting Posters
Iatrogenic Splenic Lesions in Surgery of Colorectal Cancer - Impact Onto the Early Postoperative and Oncological Long-Term Result
Ralf Steinert1,2, Ingo Gastinger1, Henry Ptok1,3, Meyer Frank*1,4, Andreas Koch1,5, Ronny Otto1, Hans Lippert1
1Institute for Quality Assurance in operative Medicine, Otto-von-Guericke University, Magdeburg, Germany; 2Dept. of General and Abdominal Surgery, St.-Josef (Municipal) Hospital, Salzkotten, Germany; 3Dept. of Surgery, Carl-Thiem (Municipal) Hospital, Cottbus, Germany; 4Dept. of General, Abdominal & Vascular Surgery, University Hospital, Magdeburg, Germany; 5Surgical Practice, Cottbus, Germany
Consequences of splenectomy in surgery for colorectal cancer(Ca) have not sufficiently investigated yet since (under normal circumstances) it is not substantial part for extended radicalness. Therefore, it appears to be of great interest what the early postoperative & oncosurgical long-term outcome of iatrogenic lesions of the spleen followed by splenectomy or reconstruction (if possible) during surgery of colorectal Ca is.
Methods: From 01/01/2000-12/31/2004, data obtained from 45,265 patients with colorectal Ca in a prospective multicenter observational study who had undergone tumor resection with curative or pal¬liative intention were analyzed with regard to early postoperative (surgical) results & survival rates affected by iatrogenic splenic lesions.
Results: In 638 patients (1.4%), iatrogenic splenic lesion occurred. In more than 80% of cases, spleen was injured in surgery of Ca of the left hemicolon & rectum. Logistic regression indicated that the crucial risk factor for this lesion was mobilization of the left colonic flexure. 126 patients (0.3%) underwent splenectomy whereas in 512 cases, spleen could be preserved. Morbidity was significantly lower without (36.0%) vs. with splenectomy (47.6%) or preservation of the spleen (48.6%), respectively. Rate of anastomotic insufficiency with need for surgical re-intervention was the highest in splenectomized patients (7.9%) whereas this rate was significantly lower in cases with splenic lesion but possible preservation of the organ (3.3%; p=0.003). Considering the overall hospital lethality of 3.1%, the specific lethality for splenectomy cases was significantly increased (11.9% / preservation of the spleen, 4.7%; p<0.0001 - no splenic lesion, 3.0%). 565 subjects agreed to register follow-up data; in 564 cases with iatrogenic splenic lesion, these data were investigated resulting in a follow-up rate of 99.8% (median follow-up period, 50.2 months). The median overall 5-year survival was 4.8 years (group I, splenic lesion with splenectomy) but it was significantly longer (8 years) in group II (preservation of the spleen), p=0.009, & there was no difference between group II & III (control with no splenic lesion). Multivariate Cox regression analysis elucidated that iatrogenic splenic lesion with splenectomy can be considered an independent risk factor for a worse oncosurgical outcome.
Conclusions: Iatrogenic lesion of the spleen requiring splenectomy in colorectal Ca surgery is a significant risk fac¬tor for a worse early postoperative surgical result (higher morbidity, lethality, rate of anastomotic insufficiency) & long-term survival, in particular, comparing the group of splenectomized patients to those with organ preservation in splenic lesion. However, according to the results, spleen-preservation should be always attempted to avoid disadvantageous effect onto the outcome.
Back to 2014 Annual Meeting Posters
|
