Objectives: The use of laparoscopy to treat malignant
hematological diseases is not completely accepted. Our
aim was to analyze operative and postoperative results of
laparoscopic splenectomy performed for benign versus
malignant hematological disorders.
Methods: Between 1994 and 2003, 76 consecutive patients
underwent laparoscopic splenectomy. The first 38
cases were performed by using an anterior approach,
whereas in the remaining 38 cases a semilateral position
was used.
Results: Baseline characteristics showed that patients
with malignant diseases were significantly older (56.9 vs
32.6 years, P 0.001). Seventy-two (94.7%) procedures
were completed laparoscopically. Conversion was required
in 4 cases (5.2%). Mean operative time was 138.5
minutes for benign and 151.0 minutes for malignant diseases,
(P 0.05, ns). The hand-assisted technique was
used in 3 patients with massive splenomegaly. Pathologic
features showed that spleen volume was higher in patients
with malignant diseases (mean interpole diameter
18.1 cm vs 13.7 cm, P 0.001). Massive splenomegaly
(interpole diameter over 20 cm, weight over 1000 g) was
present in 13 patients (17.1%); 9 had malignant diseases.
Overall perioperative mortality was 1.3% and major postoperative
complications occurred in 6 patients (7.8%).
Postoperative splenoportal partial thrombosis was identified
in 9.7% of patients.
Conclusions: Laparoscopic splenectomy is a well-accepted,
less-invasive procedure for hematological disorders.
Neoplastic diseases or splenomegaly, or both, do not
seem to limit the indications for a minimally invasive
approach after the learning curve
