Splenectomy during cytoreductive surgery in epithelial ovarian cancer

Figures & data

Table 1 Characteristics of patients

Characteristics	No.	%
Age (years), median (range)	53 (34–75)
Cytoreductive surgery
Primary	7	18.4
Secondary	24	63.2
Tertiary	6	15.8
Beyond tertiary cytoreduction	1	2.6
Stage
I–II	2	5.3
III	27	71.0
IV	9	23.7
Histological subtype
Serous	28	73.7
Endometrioid	4	10.5
Clear cell	3	7.9
Müllerian ductal	3	7.9
Differentiation grade
G1	9	26.3
G2	10	26.3
G3	14	31.6
Unknown	5	15.8
Reason for splenectomy
Achieve optimal cytoreduction	37	97.4
Intraoperative trauma	1	2.6
Complications
Thromboembolic	1	2.6
Pulmonary infection	2	5.2
Residual diseasea
Optimal	34	91.9
Suboptimal	3	8.1
Type of splenic involvementa
Implantation metastasis	27	73
Hematogenous metastasis	10	27
The sensitive to first-line
chemotherapya
Platinum sensitive	22	59.5
Platinum resistance	15	40.5

Note:

a Cases in which splenectomy was performed due to intraoperative trauma were excluded.

Figure 1 The overall survival and postsplenectomy survival by splenectomy.

Figure 2 The overall survival and postsplenectomy survival by splenectomy of the cases of splenic involvement presenting implanted metastasis vs hematogenous metastasis.

Figure 3 The overall survival and postsplenectomy survival by splenectomy of the cases with platinum sensitivity vs platinum resistance.

Figure 4 The overall survival and postsplenectomy survival by splenectomy of the cohort of patients who underwent suboptimal and optimal cytoreduction.

Table 2 Multivariate analysis of postsplenectomy survival in cytoreductive surgery (P=0.01)

Covariate	Risk	95% CI	P
First-line chemotherapy
Sensitive	1
Resistance	4.73	1.19–18.7	0.027
Residual disease
Optimal	1
Suboptimal	8.78	1.42–54.5	0.020

Table 3 Summary of literature review of splenectomy as a part of cytoreductive surgery in ovarian cancer

Study	Patient (n)	Negative control group	FIGO stage	Histological	Cytoreductive surgery	Residual disease	Major complications (overall morbidity, mortality)	Reason for splenectomy	Median survival (range)	Independent risk factors
Chen et al^Citation47	35	No	I=8.6% II=5.7% III=68.6% IV=17.1%	Serous= 78.8%	Primary=37%secondary=63%	Optimal=91.4%	Fever; effusion(23.1%–28.6%, 2.8%)	Metastasis=100%	Secondary=41 months	No mention
Ayhan et al^Citation20	34	No	III=100%	Serous= 67.6%	Primary=100%	Optimal =100%	Fever; thrombocytosis(29.4%, 8.8%)	Metastasis =52.9%	Splenic metastasis= 28.9 months	Histologic type; performance status
Eisenkop et al^Citation37	49	Splenectomy not required	III=100%	Serous= 79.6%	Primary=100%	Optimal =100%	Coagulopathy; sepsis (–, –)	Metastasis =100%	Splenectomy= 56.4 months; control group=76.8 months	Completeness of cytoreduction; sum of rankings
Magtibay et al^Citation36	112	No	I=3% II=3% III=75% IV=20%	Serous= 53%	Primary=58.9%secondary=41.1%	Optimal=37%	Thrombocytosis;wound infections;sepsis(15%, 5%)	Metastasis=87%injury=13%	Primary=21.6 months secondary=20.3 months	Residual disease status inthe primary group
Manci et al^Citation17	24	No	III=87.5%	Serous= 58%	Secondary=100%	Optimal=67%	Embolism; small bowel obstruction(29%, –)	Metastasis=100%	Progression free=34 months;OS=56 months	Completely cytoreduced;platinum-basedchemotherapy;DFI
Hanprasertpong and Fujiwara^Citation21	6	No	I=16.7% III=50% IV=33.3%	Serous= 50%	Secondary=100%	Optimal=83.3%	N(0%, 0%)	Metastasis=100%	Short to date follow up time	Isolated lesion; recurrencefree interval
McCann et al^Citation45	44	With nosplenectomy	III=66% IV=34%	Serous= 89%	Primary=100%	Optimal=84%	Ileus; septicembolism(−, −)	Metastasis=82%injury =18%	Splenectomy=30 months;control group =36 months	Only in entire cohort:optimal cytoreduction
Zapardiel et al^Citation48	33	With nosplenectomy	III=51.5% IV=48.5%	Serous= 72.7%	Primary=100%	Optimal=81.8%	Pleural effusion(−, −)	Metastasis=100%	Mean follow-up time =32months	No difference
Bacalbasa et al^Citation8	66	No	III=71.2% IV=28.8%	Serous= 92.4%	Primary=100%	Optimal=86.4%	Pancreatic fistulas;abdominal abscess(30%, 7%)	Metastasis=100%	Peritoneal seeding=58.4 months; parenchymatous=24.5 months	Peritoneal seeding
Xiang et al^Citation7 (with distal pancreatectomy)	18	No	III=78.8% IV=22.2%	Serous=100%	Primary=50%secondary=50%	Optimal=100%	Pancreatic fistula(44%, 0%) (with distalpancreatectomy)	Metastasis=100%	2-year PFS=40.2%2-year OS=84.8%	No mention
This study	38	No	I–II=5.3% III=71.0% IV=23.7%	Serous= 73.7%	Primary=18.4%secondary=63.2%tertiary=15.8%	Optimal=91.9%	Pulmonary infections(8.1%, 0%)	Metastasis=97.4%injury =2.6%	Median survival=106 months secondary=101 months	Chemosensitivity residualdisease

Notes: No mention of the specific figure.

Abbreviations: PFS, progression-free survival; OS, overall survival; DFI, disease-free interval.

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