Study of the Clinical Indications for Elective Splenectomy in Patients at Hospital Universitário Maria Aparecida Pedrossian over the Last 3 Years
DOI:
https://doi.org/10.21270/archi.v15i11.6897Keywords:
Hematologic Diseases, Splenectomy, Therapeutic UsesAbstract
Elective splenectomy indications mainly comprise benign and malignant hematologic diseases, with refractory immune thrombocytopenic purpura (ITP), autoimmune hemolytic anemia, hereditary spherocytosis, hemoglobinopathies with hypersplenism, and lymphomas or leukemias with splenic involvement standing out. Despite its efficacy, the surgical decision must weigh postoperative infectious and thromboembolic risks, reinforcing the need for careful patient selection. The study was a cross-sectional observational study involving the selection of 11 participants who were referred to the digestive surgery department of Hospital Universitário Maria Aparecida Pedrossian with a clinical indication for elective splenectomy over the last 3 years. Medical records were reviewed to characterize the patient, the clinical condition that led to the surgical indication, and aspects of the procedure itself. Afterward, laboratory data obtained 3 months after surgery were evaluated to assess resolution of the underlying condition that had led to the splenectomy indication. The clinical indications for elective splenectomy in this study are predominantly concentrated in hematologic diseases, with refractory immune thrombocytopenic purpura standing out, followed by hypersplenism associated with hemoglobinopathies and diagnostic investigation of splenomegaly of undefined etiology. The surgical approach tends to follow spleen volume, with larger spleens preferentially operated on via open surgery, which is associated with a higher risk of severe hemorrhagic complications in the immediate postoperative period. Clinical response after the procedure tends to be favorable for benign hematologic indications, reinforcing splenectomy as a relevant therapeutic tool when well indicated and selectively applied.
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1. Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113(11):2386-93.
2. Neunert C, Terrell DR, Arnold DM, Buchanan G, Cines DB, Cooper N, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019;3(23):3829-66.
3. Chater C, Terriou L, Duhamel A, Launay D, Chambon JP, Pruvot FR, et al. Reemergence of splenectomy for ITP second-line treatment? Ann Surg. 2016;264(5):772-7.
4. Sharma A, Easow Mathew M, Puri L. Splenectomy for people with thalassaemia major or intermedia. Cochrane Database Syst Rev. 2019;9:CD010517.
5. Essa M, Algeri M, Alzahrani M, et al. Conditioning regimen for hematopoietic cell transplant in transfusion dependent thalassemia: recommendations from the EBMT practice harmonisation and guidelines committee. Bone Marrow Transplant. 2026.
6. Musallam KM, Khalife M, Sfeir PM, et al. Postoperative outcomes after laparoscopic splenectomy compared with open splenectomy. Ann Surg. 2013;257(6):1116-23.
7. Rodríguez-Luna MR, Balagué C, Fernández-Ananín S, Vilallonga R, Targarona Soler EM. Outcomes of laparoscopic splenectomy for treatment of splenomegaly: a systematic review and meta-analysis. World J Surg. 2021;45(2):465-79.
8. Shin RD, Lis R, Levergood NR, et al. Laparoscopic versus open splenectomy for splenomegaly: the verdict is unclear. Surg Endosc. 2019.
9. Casaccia M, Sormani MP, Palombo D, Dellepiane C, Ibatici A. Laparoscopic splenectomy versus open splenectomy in massive and giant spleens: should we update the 2008 EAES guidelines? Surg Laparosc Endosc Percutan Tech. 2019;29(3):178-81.
10. Taner T, Nagorney DM, Tefferi A, Habermann TM, Harmsen WS, Slettedahl SW, et al. Splenectomy for massive splenomegaly: long-term results and risks for mortality. Ann Surg. 2013;258(6):1034-9.
11. Sociedade Brasileira de Infectologia. Imunização de pacientes esplenectomizados não imunossuprimidos. Disponível em: https://infectologia.org.br
12. Dan CA, Sima LV, Dan RG, Ioniță I, Crețu OM, Brează GM, Sima AC, Ioniță C. The Current Role and Relevance of a Splenectomy in Immune Thrombocytopenic Purpura Patients-A Single-Center Experience. Medicina (Kaunas). 2025;61(4):578.
13. Zoletto S, Pizzi M, De Crescenzo A, Friziero A, D'Amore F, Carli G, et al. Predictors of Splenectomy Response in Immune Thrombocytopenia: A Multicentric Italian Study. J Clin Med. 2024;14(1):30.
14. Meng M, Choi PJK, Pydi R, Farkas DT. Evaluating the Effectiveness of Laparoscopic Removal of an Accessory Spleen After a Failed Splenectomy for Immune Thrombocytopenia. Cureus. 2024;16(7):e65876.
15. Fernández-Ananin S, Novelli S, Cambeiro Cabré L, Vila Riera C, Ballester Vàzquez E, Julià Verdaguer E, et al. Elective splenectomy for hematological diseases: a vanishing indication. Surg Endosc. 2024;38(11):6332-6337.
16. Rabinovich E, Pradhan K, Islam I, Davido HT, Gali R, Muscarella P, et al. Splenomegaly and Response to Splenectomy in Immune Thrombocytopenia. J Clin Med. 2024;13(13):3712.
17. Alkhelaiwy L, Fatani JA, Alhamoud I, Chaballout A. Immune Thrombocytopenia After COVID-19 Vaccine Requiring Splenectomy: A Case Report and Review of the Literature. Cureus. 2024;16(2):e53955.
18. Baldari L, Boni L, Giuliani B, Cassinotti E. Porto-spleno-mesenteric venous thrombosis after elective splenectomy: a retrospective cohort study. Front Immunol. 2023;14:1216283.
19. Baz C, Pozza G, Di Pangrazio M, Toti F, Dreifuss NH, Cubisino A, et al. Robotic surgery: extending the minimally invasive approach in patients with splenomegaly. A case report. J Surg Case Rep. 2023;2023(6):rjad325.
20. Tivadar BM, Minciună CE, Coriu D, Coliţă A, Vasilescu C. The Decline of Open, Laparoscopic, and Robotic Splenectomies: A Single Center Experience. Chirurgia (Bucur). 2024;119(2):184-190.
21. Zhu QL, Wu W. Comparison of clinical efficacy of laparoscopic splenectomy versus open splenectomy for idiopathic thrombocytopenic purpura: A meta-analysis. Medicine (Baltimore). 2021;100(4):e24436.
22. Protocolo Clínico e Diretrizes Terapêuticas para Anemia Hemolítica Autoimune. Relatório de Recomendação. [s.l: s.n.]. Disponível em: <https://www.gov.br/conitec/pt-br/midias/consultas/relatorios/2024/relatorio-preliminar-pcdt-anemia-hemolitica-autoimune-cp51>.
23. Ministério da Saúde Secretaria de Atenção Especializada à Saúde Secretaria de Ciência, Tecnologia e Insumos Estratégicos Portaria Conjunta no. [s.l: s.n.]. Disponível em: <https://www.gov.br/conitec/pt br/midias/protocolos/pcdt_purpuratrombocitopenicaidiopatica.pdf>.
