Laparoscopic splenectomy in malignancies: is it safe and feasible?

BACKGROUND: Laparoscopic Splenectomy (LS) is considered the treatment of choice for benign hematologic diseases of the spleen. However, the role of LS in malignancies is still controversial. Technical difficulties, hemorrhagic risk, the need of pathological characterisation of malignant disease, may be considered contraindications to LS in malignancies. This study aims to verify the efficacy and feasibility of LS for hematologic malignancies. METHODS: 145 patients underwent LS for hematologic disease and were retrospectively shared in two groups: Group A (83 patients) patients with preoperative diagnosis of benign hematologic disease and Group B (62 patients) with malignancies. Bipolar spleen diameter, mean operative time, conversion rate and causes, complications and need of transfusion were evaluated. RESULTS: Median splenic diameter was greater in Group B than in Group A with a statistically significant difference (p<0.005), such as higher were the number of accessory mini-laparotomy (p<0.005) and conversion rate (p=0.024) in the group of patients with a diagnosis of malignancy. The mean operative time was 117.6 min. in group A and 148.1 min. in Group B (p<0.005). Besides, there were no significant differences relative to intra-operative and postoperative transfusions and the incidence of postoperative complications. No peri-operative mortality occurred. CONCLUSIONS: The analysis of our data highlights that LS for hematologic malignancies is effective and feasible even if it associated with higher conversion rate due to splenomegaly and difficult hilum dissection. Besides, no differences in the patient outcome were highlighted. LS may be considered a safe procedure in the treatment of haematological malignancies of the spleen.