Laparoscopic Splenectomy for Malignant Diseases

  • B. Todd Heniford
  • R. Matthew Walsh


Since Delaitre and Maignien1 reported the first laparoscopic splenectomy in 1991, the utility of laparoscopic splenectomy in the treatment of hematologic diseases such as hereditary spherocytosis, immune thrombocytopenic purpura, and autoimmune hemolytic anemia has been well established. More than 1,000 cases in the surgical literature have documented laparoscopic splenectomy as safe and effective in the management of these benign hematologic disorders. As with other minimally invasive surgical techniques when compared to conservative or open surgery, patients appear to benefit from an earlier intake of a regular diet, reduced postoperative analgesic requirements, a shorter postoperative hospital stay, and an improved cosmetic result. Additionally, the period of convalescence is brief, with an early return to work or normal activities. Although no prospective, randomized, controlled trials comparing open splenectomy with laparoscopic splenectomy have been completed or are ever likely to be done, retrospective case-control series in both children and adults consistently favor the laparoscopic approach.2–9 Although the minimally invasive method for splenic resection is now considered the “gold standard” for the treatment of benign hematologic diseases, a long-term evaluation of its hematologic benefits needs to be completed10 and is ongoing in ours and several other centers.


Immune Thrombocytopenic Purpura Laparoscopic Splenectomy Hairy Cell Leukemia Laparoscopic Staging Hereditary Spherocytosis 
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  1. 1.
    Delaitre B, Maignien B. Splenectomy by the laparoscopic approach. Report of a case. Presse Med 1991; 20: 2263.Google Scholar
  2. 2.
    Diaz J, Eisenstat M, Chung R. A case-controlled study of laparoscopic splenectomy. Am J Surg 1997; 173: 348–350.PubMedCrossRefGoogle Scholar
  3. 3.
    Katkhouda N, Hurwitz MB, Rivera RT, et al. Laparoscopic splenectomy: outcomes and efficacy in 103 consecutive patients. Ann Surg 1998; 228: 568–578.PubMedCrossRefGoogle Scholar
  4. 4.
    Yee LF, Carvajal SH, de Lorimier AA, et al. Laparoscopic splenectomy: the initial experience at University of California, San Francisco. Arch Surg 1995; 130: 874–879.PubMedCrossRefGoogle Scholar
  5. 5.
    Emmermann A, Zornig C, Peiper M, et al. Laparoscopic splenectomy. Technique and results in a series of 27 cases. Surg Endosc 1995; 9: 924–927.PubMedGoogle Scholar
  6. 6.
    Brunt LM, Langer JC, Quasebarth MA, et al. Comparative analysis of laparoscopic vs open splenectomy. Am J Surg 1996; 172: 596–601.PubMedCrossRefGoogle Scholar
  7. 7.
    Smith CD, Meyer TA, Goretsky MJ, et al. Laparoscopic splenectomy by the lateral approach: a safe and effective alternative to open splenectomy for hematologic diseases. Surgery 1996; 120: 789–794.PubMedCrossRefGoogle Scholar
  8. 8.
    Walkhausen JH, Tapper D. Is pediatric laparoscopic splenectomy safe and cost-effective? Arch Surg 1997; 132: 822–824.CrossRefGoogle Scholar
  9. 9.
    Janu PG, Rogers DA, Lobe TE. A comparison of laparoscopic and traditional open splenectomy in childhood. J Pediatr Surg 1996; 31: 109–114.PubMedCrossRefGoogle Scholar
  10. 10.
    Friedman RL, Laparoscopic splenectomy for ITP: the gold standard. 25. Surg Endosc 1996; 10: 991–995.PubMedCrossRefGoogle Scholar
  11. 11.
    Janu PG, Rogers DA, Lobe TE. A comparison of laparoscopic and traditional open splenectomy in diseases: certitudes and unresolved issues. Semin Laparosc Surg 1998; 5: 147–167Google Scholar
  12. 12.
    Kyzer S, Koren R, Klein B, et al. Giant splenomegaly caused by splenic metastases of melanoma. Eur J Surg 1998; 24: 336–337.Google Scholar
  13. 13.
    Giulliani A, Caporale A, Di Bari M, et al. Isolated splenic metastasis from endometrial carcinoma. J Exp Clin Cancer Res 1999; 18: 93–96.Google Scholar
  14. 14.
    Gemignani ML, Chi DS, Gurin CC, et al. Splenectomy in recurrent epithelial ovarian cancer. Gynecol Oncol 1999; 72: 407–410.PubMedCrossRefGoogle Scholar
  15. 15.
    Mallipudi BV, Chawdhery MZ, Jeffery PJ. Primary malignant fibrous histiocytoma of spleen. Eur J Surg Oncol 1998; 24: 448–449.PubMedCrossRefGoogle Scholar
  16. 16.
    Colovic MD, Jankovic GM, Colovic RB, et al. Non-secretory solitary plasmacytoma of the spleen. Med Oncol 1998; 15: 286–288.PubMedCrossRefGoogle Scholar
  17. 17.
    Tubiana M. Hodgkin’s disease: historical perspective and clinical presentation. In: Bailliere’s Clinical Haematology, vol. 9. Philadelphia: Balliere Tindall, 1991; 503–530.Google Scholar
  18. 18.
    Mauch PM. Management of early stage Hodgkin’s disease. In: Bailliere’s Clinical Haematology, vol. 9. Philadelphia: Balliere Tindall, 1996; 531–541.Google Scholar
  19. 19.
    Lister TA, Crowther D, Sutcliffe SB, et al. Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin’s disease. J Clin Oncol 1989; 7: 1630–1636.PubMedGoogle Scholar
  20. 20.
    Specht L, Lauritzen AF, Nordentoft AM, et al. Tumor cell concentration and tumor cell burden in relation to histopathologic subtype and other prognostic factors in early stage Hodgkin’s disease. The Danish National Hodgkin’s Study Group. Cancer 1990; 65: 2594–2601.PubMedCrossRefGoogle Scholar
  21. 21.
    Leibenhaut M. Prognostic indicators of laparotomy findings in clinical stage I-II supradiaphragmatic Hodgkin’s disease. J Clin Oncol 1989; 7: 8191.Google Scholar
  22. 22.
    Mauch P, Larson D, Osteen R, et al. Prognostic factors for positive staging in patients with Hodgkin’s disease. J Clin Oncol 1990; 8: 257–265.PubMedGoogle Scholar
  23. 23.
    Jockovick M, Mendenhall NP, Sombeck MD, et al. Long-term complications of laparotomy in Hodgkin’s disease. Ann Surg 1994;219(6):615624.Google Scholar
  24. 24.
    Lehne G, Hannisdal E, Langholm R, Nome O. A 10 year experience with splenectomy in patients with malignant non-Hodgkin’s lymphoma. Cancer 1994; 74: 933–939.PubMedCrossRefGoogle Scholar
  25. 25.
    Delpero JR. Splenectomy for hypersplenism in chronic lymphocytic leukemia and malignant non-Hodgkin’s lymphoma. Br J Surg 1990; 77: 443–449.PubMedCrossRefGoogle Scholar
  26. 26.
    Brox A, Bishinski JI, Berry G. Primary non- 42. Hodgkin’s lymphoma of the spleen. Am J Hematol 1991; 38: 95–100. 43.Google Scholar
  27. 27.
    Brodsky J, Abcar A, Styler M. Splenectomy for non-Hodgkin’s lymphoma. Am J Clin Oncol 1996; 19: 558–561.PubMedCrossRefGoogle Scholar
  28. 28.
    Backus CL, Walsh RM, Matthews BD, Pratt BL, Heniford BT. Criteria for adding a hand-assisted technique in laparoscopic splenectomy in patients with massive splenomegaly. Abstract, Society of American Gastrointestinal Endoscopie Surgeons, March, 2000, Atlanta, GA.Google Scholar
  29. 29.
    Jacobs P, King HS, Dent DM. Splenectomy as the primary treatment of hairy cell leukemia. Br J Surg 1987; 74: 1169–1174.PubMedCrossRefGoogle Scholar
  30. 30.
    Flowers JL, Lefor AT, Steers J, et al. Laparoscopic splenectomy in patients with hemolytic diseases. Ann Surg 1996; 224: 19–28.PubMedCrossRefGoogle Scholar
  31. 31.
    McMullin M. Treatment following splenectomy. Br Med J 1993; 307: 1372–1373.CrossRefGoogle Scholar
  32. 32.
    Konradsen HB. Humoral immune response to pneumococcal vaccination: prevention of infections with Streptococcus pneumonia by immunization. APMIS 1996;suppl 60: 1–28.Google Scholar
  33. 33.
    Nicholson IA, Falk GI, Muligan SC. Laparoscopically assisted massive splenectomy: a preliminary report of the technique of early hilar devascularization. Surg Endosc 1998; 12: 73–75.PubMedCrossRefGoogle Scholar
  34. 34.
    Bove T, Delvaux G, Van Eijkelenburg P, et al. Laparoscopic-assisted surgery of the spleen: clinical experience in expanding indications. J Laparoendosc Surg 1996; 6: 213–217.PubMedCrossRefGoogle Scholar
  35. 35.
    Targarona EM, Espert JJ, Balague C, et al. Splenomegaly should not be considered a contraindication for laparoscopic splenectomy. Ann Surg 1998; 228: 35–39.PubMedCrossRefGoogle Scholar
  36. 36.
    Kusminsky RE, Boland JP, Tiley EH. Hand-assisted laparoscopic splenectomy. Surg Laparosc Endosc 1995; 5: 463–467.PubMedGoogle Scholar
  37. 37.
    Park A, Gagner M, Pomp A. The lateral approach to laparoscopic splenectomy. Am J Surg 1997; 173: 126–130.PubMedCrossRefGoogle Scholar
  38. 38.
    Klinger PJ, Tsiotos GG, Glaser KS, et al. Laparoscopic splenectomy: evolution and current status. Surg Laparosc Endosc 1999; 9: 1–8.CrossRefGoogle Scholar
  39. 39.
    Poulin EC, Thibault C. The anatomical basis for laparoscopic splenectomy. Can J Surg 1993; 36: 484–488.PubMedGoogle Scholar
  40. 40.
    Katkhouda N, Waldrep DJ, Feinstein D, et al. Unresolved issues in laparoscopic splenectomy. Am J Surg 1996; 172: 585–590.PubMedCrossRefGoogle Scholar
  41. 41.
    Grossbard ML. Is laparoscopic splenectomy appropriate for the management of hematologic 57. and oncologic diseases? Surg Endosc 1996; 10: 387–390PubMedCrossRefGoogle Scholar
  42. 42.
    Schlinkert RT, Teotia SS. Laparoscopic splenectomy. Arch Surg 1999; 134: 99–103PubMedCrossRefGoogle Scholar
  43. 43.
    Poulin EC, Mamazza J. Laparoscopic splenectomy: lessons learned from the learning curve. Can J Surg 1998; 41: 28–36.PubMedGoogle Scholar
  44. 44.
    Rhodes M, Rudd M, O’Rourke N, et al. Laparoscopic splenectomy and lymph node biopsy for hematologic disorders. Ann Surg 1995; 222: 43–46PubMedCrossRefGoogle Scholar
  45. 45.
    Trias M, Targarona EM, Espert JJ, et al. Laparoscopie splenectomy for splenic disorders: lessons learned from a series of 64 cases. Surg Endosc 1998; 12: 66–72.PubMedCrossRefGoogle Scholar
  46. 46.
    Walsh RM, Heniford BT. Laparoscopic splenectomy for non-Hodgkin’s lymphoma. J Surg On-col 1999; 70: 116–121.Google Scholar
  47. 47.
    Walsh RM, Heniford BT. Role of laparoscopy for Hodgkin’s and non-Hodgkin’s lymphoma. Semin Surg Oncol 1999; 16: 284–292.PubMedCrossRefGoogle Scholar
  48. 48.
    Poulin E, Thibault C, Mamazza J, et al. Laparoscopic splenectomy: clinical experience and the role of preoperative splenic artery embolization. Surg Laparosc Endosc 1995; 3: 445–450.Google Scholar
  49. 49.
    Friedman RL, Hiatt JR, Korman JL, et al. Laparoscopie or open splenectomy for hematologic disease: which approach is superior? J Am Coll Surg 1997; 185: 49–54.PubMedGoogle Scholar
  50. 50.
    Schlachta CM, Poulin EC, Mamazza J. Laparoscopic splenectomy for hematologic malignancies. Surg Endosc 1999; 13: 865–868.PubMedCrossRefGoogle Scholar
  51. 51.
    Decker G, Millat B, Guillon F, et al. Laparoscopic splenectomy for benign and malignant diseases: 35 consecutive cases. World J Surg 1998; 22: 6268.CrossRefGoogle Scholar
  52. 52.
    Dawson AA, Jones PF, King DJ. Splenectomy in the management of haematological disease. BrJ Surg 1987; 74: 353.CrossRefGoogle Scholar
  53. 53.
    Wilson RE, Rosenthal DS, Moloney WC, et al. Splenectomy for myeloproliferative disorders. World J Surg 1985; 9: 431–438.PubMedCrossRefGoogle Scholar
  54. 54.
    MacRae HM, Yakimets WW, Reynolds T. Peri-operative complications of splenectomy for hematologic disease. Can J Surg 1992; 35: 432–437.PubMedGoogle Scholar
  55. 55.
    Horowitz J, Smith JL, Weber TK, et al. Postoperative complications after splenectomy for hematologic malignancies. Ann Surg 1996; 223: 290–296.PubMedCrossRefGoogle Scholar
  56. 56.
    Barillari G, Silvestri F, Fanin R, et al. Surgical staging in Hodgkin’s disease: the role of laparoscopic splenectomy. Eur J Haematol 1996; 57: 114–116.PubMedCrossRefGoogle Scholar
  57. 57.
    Ferzli G, Fiorillo A, Solis R, et al. Laparoscopic staging of Hodgkin’s disease. J Laparoendosc [A] Surg Tech 1997; 7: 353–355.CrossRefGoogle Scholar

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© Springer Science+Business Media New York 2001

Authors and Affiliations

  • B. Todd Heniford
  • R. Matthew Walsh

There are no affiliations available

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