Influence of Splenectomy on Morbidity of Esophageal Cancer Surgery

Background And Aim: During esophagectomy, splenic injury may occur due to unintentional operative trauma, caused by excessive traction on the splenic ligaments or misplacement of re-tractors. The role of spleen in immune system is well recognized and the addition of splenectomy to esophagectomy may increase the rate of complications. The goal of this study was to determine the influence of splenectomy on postoperative morbidity and mortality after esophageal resection for esophageal cancer.

Materials And Methods: Between January 2001 and April 2006, 420 cases with esophageal cancer underwent esophagectomy in a referral cancer institute. In 14 patients (3.3%) splenectomy was added because of unwanted splenic injury during operation. In-hospital morbidities and mortality and hospital stay were compared between patients with and without concomitant splenectomy.

Results: Although the overall complication rate in splenectomized patients was higher than other patients (43% vs. 30%), this figure was not statistically significant (P value: 0.3). Cervical anastomotic leakage occurred in 35.7% of splenectomized patients in comparison to 12.2% of control group (P value: 0.01, Odds Ratio: 3.93, CI95%: 1.27-12.2). There were no significant differences in cardiac and pulmonary complications, and in-hospital mortality rate between patients with and without splenectomy (P value > 0.05). Splenectomy did significantly affect post operative hospital stay (19 +/- 13 vs. 13 +/- 7 days, P value: 0.004).

Conclusions: During esophagectomy, unplanned splenectomy may increase the incidence of anastomotic leakage and hospital stay. Therefore, whenever possible preservation of the spleen should be considered. An unexpected relationship between splenectomy and anastomotic leaks needs further investigation.Key words: Esophageal cancer; esophagectomy; splenectomy; esophagus; leakage; morbidity; mortality; complication.