The risks and benefits of non-predictive splenectomy: The necessity of splenectomy and early postoperative outcomes

Although, most splenectomy is predictive due to preoperative tests, sometimes the decision to perform the splenectomy is made intraoperatively for non-primary splenic diseases. The aim of this study to investigate the risks, benefits and necessity of non-predictive of splenectomy and early outcomes. Splenectomy was performed as predictive splenectomy (PS) for primary splenic diseases and non-predictive splenectomy (Non-PS) for non-primary splenic diseases. Preoperative, operative, and 1-month postoperative data included to study. Between June 2012 and July 2018, 108 patients underwent splenectomy. Of these patients, 67 (62%) had PS for primary splenic disease, and 41 (38%) had non-PS due to non-primary splenic diseases. Patients with PS were statistically younger compared to Non-PS patients (52.82 ± 15.07 vs. 44.32 ± 19.23 years, p = 0.022). The most common cause of splenectomy in the PS group was immune thrombocytopenic purpura (ITP) in 16 (23.9%) and splenic trauma in 16 (23.9%), whereas in the non-PS group the major causes were gastric cancer in 16 (39%) and pancreas cancer in 10 (24.4%). Patients in the PS group had significantly lower postoperative hospital stay day (11.2 ± 7.3 vs. 6.4 ± 4.2, p = 0.001). The total complication rate was statistically higher in the non-PS patients (31.7% vs. 10.4%, p = 0.012). However, no significant differences were found in the postoperative infection rates (17% in non-PS versus 7.5% in PS, p = 0.22). Even if the preoperative investigation does not show any indication for splenectomy, but the surgeon has intraoperative concerns about sub-optimal oncological surgery without splenectomy, we recommend that the surgeon should perform the splenectomy.