Partial splenectomy: A case series and systematic review of the literature

Abstract

Backgrounds/aims: Partial splenectomy (PS) is a surgical option for splenic mass, in order to reduce postoperative complications and preserve the splenic function. Despite this, data in literature is still scarce. The present study aimed to reveal our recent experience and provide a comprehensive overview of the feasibility and complications related to various surgical approaches.

Methods: Data of patients who underwent PS, between 2014 and 2017 were retrospectively reviewed. Literature was searched for studies reporting all types of PS in adult or adolescent patients.

Results: Five PS were performed in our department: two (40%) by laparoscopy and three (60%) by laparotomy. Two (40%) postoperative complications were detected, and in one of them, total splenectomy (TS) by laparotomy was finally required. There were no deaths or complications at last follow-up. Twenty studies including 213 patients were identified in the literature search. The rate of conversion from laparoscopic to open surgery was 3% (range, 5-50%) and in 3% of cases (range, 7-10%) PS was converted into total TS and the overall morbidity rate was 8% (range, 5-25%). In comparison to laparotomy, the conversion rate of laparoscopic approach to TS was 3.5% (vs. 1.4%) and a morbidity rate of 9.8% (vs. 4.3%).

Conclusions: The present review shows that PS is a viable procedure in selected cases. The mini-invasive approach seemed to be feasible despite the presence of higher rate of complications than the open technique. In future, further studies on this topic are needed by involving more patients. Furthermore, it is proposed that the development of robotic surgery could make this approach the new gold-standard technique for spleen-preserving surgery.

Keywords: Laparoscopic partial splenectomy; Partial splenectomy; Systematic review.

Fig. 1. Case no. 5. (A) Preoperative computed tomography: the arrow shows the splenic mass. (B) Intraoperative view of the splenic mass after removal. (C) Intraoperative view of the splenic residual parenchyma. (D) Macroscopic examination of the surgical piece. (E) 3D reconstruction of the remaining splenic parenchyma at three months after surgery.

Fig. 2. Flow chart demonstrating study search, selection and inclusion criteria. Example of search equation: (Partial splenectomy [Title/Abstract]) OR (laparoscopic partial splenectomy [Title/Abstract]) OR (Hemisplenectomy [Title/Abstract]) OR (subtotal splenectomy) OR (partial spleen resection [Title/Abstract]) OR (hemi-splenectomy [Title/Abstract]) AND (Humans [Mesh]) AND (adult [MeSH]).