Complications following cytoreductive surgery for Stage III or IV epithelial ovarian cancer with or without splenectomy are described, and opportunities for better post-splenectomy treatment are highlighted. With the use of the institutional database Gynecologic Oncology Longitudinal Data Collection and Utilization Program (GOLD CUP), researchers identified all patients who underwent cytoreductive surgery for ovarian cancer between 2008 and 2018. Patient characteristics, co-morbidities, disease stage, operative and post-operative details, readmission rates, progression-free survival, overall survival, and death from the disease were compared between those who underwent splenectomy and those who did not as part of cytoreductive surgery.
Metrics for service quality include the distribution of splenectomy-related educational materials and the administration of vaccinations against encapsulated organisms. To conduct the statistical analysis, STATA SE 16.0 was used. At the time of primary or interval cytoreductive surgery, they found 47 patients who had a splenectomy and 454 patients who did not. About 1 (2.1%), 26 (55.3%), 7 (14.9%), and 13 (27.7%) patients reached the terminal IIIB, IIIC, IVA, or IVB stages, respectively. Those who had their spleens removed were at a far more advanced stage. It took longer to recover after surgery, patients spent more time in the hospital, and more blood was transfused following splenectomy, but there was no increase in the risk of infection, readmission, or mortality. About 4/47 patients (8.5%) had pancreatic leakage.
About 42/47 patients (89.4%) were found to have had vaccines after splenectomy. Instructions for discharge following splenectomy were given to just 2 of 47 patients (4.3%), and only 3 of 7 patients (42.9%) were given aspirin for platelets 1 million or more. Although splenectomy is associated with increased morbidity, it continues to be of benefit to individuals who have complete cytoreduction. Vaccination rates, the accuracy of patient discharge information, and the prompt treatment of pancreatic fistulas are all areas where post-splenectomy care should be improved.
Source: sciencedirect.com/science/article/abs/pii/S0090825822005777
