Introduction: A splenectomy is frequently performed during debulking surgery for advanced ovarian cancer. Its impact on perioperative and survival outcomes remains questionable as current evidence is conflicting. In the present study, we sought to determine the factors that affect survival rates in ovarian cancer patients that undergo a splenectomy as part of maximal-effort cytoreduction. Patients and methods: A retrospective chart review was conducted that included all epithelial ovarian cancer patients that had surgical cytoreduction for advanced epithelial ovarian cancer. Differences among splenectomized and non splenectomized patients were evaluated as well as the impact of known risk factors on survival outcomes of splenectomized patients. Results: Overall, 245 patients were identified and 223 were included in the present series, of whom 91 had a splenectomy. Recurrence rates as well as death rates were comparable among splenectomized and non-splenectomized patients; however, both the disease-free survival (log-rank= 0.001), as well as the overall survival of splenectomized patients (log-rank= 0.006), was shorter. Thrombotic events as well as rates of pulmonary embolism were comparable. Sepsis was more common among splenectomized patients. The site of splenic metastases did not influence patients’ survival. Among splenectomized patients, those offered primary debulking had longer progression-free survival (log-rank= 0.042), although their overall survival did not differ compared to patients submitted to interval debulking. Complete debulking significantly improved the overall survival compared to optimal debulking (log-rank= 0.047). Splenectomized patients that developed sepsis had worse overall survival (log-rank= 0.005). Discussion: The findings of our study support the feasibility of splenectomy in advanced epithelial ovarian cancer; however, its impact on patients’ survival is considerable. Therefore, every effort should be made to avoid splenic injury which will result in unintended splenectomy for non-oncological reasons.
引言：在晚期卵巢癌的肿瘤细胞减灭术中，脾切除术常作为手术的一部分。由于现有证据存在矛盾，脾切除术对围手术期及生存结局的影响仍存争议。本研究旨在探讨接受最大程度肿瘤细胞减灭术的卵巢癌患者中，影响脾切除术后生存率的因素。 患者与方法：本研究通过回顾性病历分析，纳入了所有接受手术细胞减灭术的晚期上皮性卵巢癌患者。评估了脾切除组与非脾切除组患者的差异，并分析了已知风险因素对脾切除患者生存结局的影响。 结果：共筛选出245例患者，其中223例纳入本系列研究，其中91例接受了脾切除术。脾切除组与非脾切除组的复发率和死亡率相当；然而，脾切除患者的无病生存期（对数秩检验P=0.001）和总生存期（对数秩检验P=0.006）均较短。两组血栓事件及肺栓塞发生率无显著差异。脾切除患者中脓毒症发生率更高。脾转移部位对患者生存率无影响。在脾切除患者中，接受初次肿瘤细胞减灭术者的无进展生存期更长（对数秩检验P=0.042），但其总生存期与接受间歇性肿瘤细胞减灭术者无差异。与满意减灭术相比，完全减灭术显著改善了总生存期（对数秩检验P=0.047）。发生脓毒症的脾切除患者总生存期更差（对数秩检验P=0.005）。 讨论：本研究结果支持脾切除术在晚期上皮性卵巢癌治疗中的可行性，但其对患者生存的影响不容忽视。因此，应尽一切努力避免因非肿瘤原因导致的脾脏损伤，从而避免非计划性脾切除术。
Splenectomy as Part of Maximal-Effort Cytoreductive Surgery in Advanced Epithelial Ovarian Cancer
肿瘤(癌症)患者之家