Surgical Endoscopy And Other Interventional Techniques

, Volume 20, Issue 8, pp 1214–1220

Laparoscopic splenectomy for hematologic diseases: a preliminary analysis performed on the Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS)

  • M. Casaccia
  • P. Torelli
  • S. Squarcia
  • M. P. Sormani
  • A. Savelli
  • B. Troilo
  • G. Santori
  • U. Valente
Article

DOI: 10.1007/s00464-005-0527-5

Cite this article as:
Casaccia, M., Torelli, P., Squarcia, S. et al. Surg Endosc (2006) 20: 1214. doi:10.1007/s00464-005-0527-5

Abstract

Background

The Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS) was developed to provide at the national level an informative tool useful for performing multicenter studies in the field of spleen laparoscopic surgery. In this first study analyzing the IRLSS data, a cohort of patients with hematologic diseases was retrospectively investigated for potential predictive parameters that could affect the outcome of laparoscopic splenectomy.

Methods

A total of 309 patients who underwent laparoscopic splenectomy for hematologic diseases in 17 Italian centers (between February 1, 1993, and September 30, 2004) were entered in the IRLSS. Their records were analyzed retrospectively by the Student’s t-test, chi-square, and logistic regression.

Results

The mean operative time was 141 min (range, 30–420 min). Conversion was necessary in 21 cases (7%), and approximately 1 accessory spleen in 25 patients (9%) was found. The mean spleen weight was 1191 g (range, 85–4,500 g). Perioperative death occurred in two cases (0.6%). No complications were experienced by 253 patients (81.9%), who had a mean hospital stay of 5.4 days (range, 2–30 days). Overall morbidity occurred in 56 patients (18.1%), mainly associated with transient fever (n = 22), pleural effusion (n = 13), and actual or suspected hemorrhage (n = 12), requiring a reintervention for 7 patients. Multivariate analysis found that body mass index (p = 0.024) and clinical indication (p = 0.004) were independent predictors for surgical conversion. The clinical indication was almost significant as an independent predictor for the occurrence of postoperative complication (p = 0.05).

Conclusions

This first study analyzing the IRLSS data shows that laparoscopic splenectomy may represent the gold standard treatment for hematologic diseases with normal-size spleen. The low morbidity and mortality rate suggests that laparoscopic splenectomy can be successfully proposed also for splenomegaly in hematologic malignancies.

Keywords

Hematologic diseasesLaparoscopyMorbidityMortalitySplenectomy

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • M. Casaccia
    • 1
  • P. Torelli
    • 1
  • S. Squarcia
    • 2
  • M. P. Sormani
    • 3
  • A. Savelli
    • 1
  • B. Troilo
    • 1
  • G. Santori
    • 1
  • U. Valente
    • 1
  1. 1.Advanced Laparoscopic Unit, Department of General Surgery and TransplantSan Martino University Hospital, University of GenoaGenoaItaly
  2. 2.Physic and Medical Statistics Laboratory, Department of PhysicUniversity of GenoaGenoaItaly
  3. 3.Clinical Epidemiology UnitNational Institute for Cancer ResearchGenoaItaly