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Eur J Cardiothorac Surg 2006;29:244-247
© 2006 Elsevier Science NL

Unplanned splenectomy during oesophagectomy does not affect survival

Department of Thoracic Surgery, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom

Received 21 April 2005; received in revised form 6 November 2005; accepted 8 November 2005.

^_* Corresponding author. Tel.: +44 7834600435. (Email: edblackis{at}hotmail.com).

Objective: There are limited and conflicting data available concerning the incidence of inadvertent splenectomy and its impact on the outcome in patients who have undergone oesophagectomy. The aim of this study is to identify the factors associated with a likelihood of inadvertent splenectomy and its influence on early and long-term outcome in patients having oesophagectomy for oesophageal carcinoma. Methods: A consecutive series of 738 oesophagectomies performed between 1991 and 2004 was analysed. In our practice, the spleen was removed only if damaged intraoperatively. Routine chemo- and immunoprophylaxis would subsequently be used. Multivariate analysis with logistic and Cox models determined significant variables. Results: Of the 738 oesophagectomies, 48 (6.5%) had splenectomy. Neoadjuvant chemotherapy was administered to a minority of patients; none subsequently had splenectomy. There were significant differences between types of operation (Ivor–Lewis 18 (9.0%), left thoracolaparotomy 14 (9.9%) and left thoracophrenotomy 15 (3.9%), p = 0.01). Splenectomy was more common with advanced N stage disease (OR = 0.44 [0.20–0.95]; p = 0.04). Splenectomy resulted in more blood transfusions (median, 2 units vs 0 units; p = 0.03) more anastomotic leaks (7 [14.6%] vs 42 [6.1%]; p = 0.02) but not an increase in pulmonary complications (p = 0.64) or in-hospital mortality (1 [4.6%] vs 37 [5.4%]; p = 0.30). Splenectomy did not significantly affect median survival (551 [332–770] days vs 627 [554–700] days; p = 0.63). Conclusion: Although inadvertent splenectomy increased the morbidity of oesophagectomy, it did not impair survival. Type of operation and advanced N stage are important risks for splenectomy. Though best avoided, most of the consequences of splenectomy can be managed. An unexpected relationship between splenectomy and anastomotic leaks needs further investigation.

Key Words: Oesophageal cancer • Oesophageal surgery • Splenectomy