Background:Splenectomy remains necessary in selected oncologic and hematologic indications but is associated with significant postoperative morbidity and mortality. The data on outcomes in this high-risk population remain limited, particularly in mixed cohorts.Methods: We conducted a retrospective cohort study including all patients undergoing splenectomy for oncologic or hematologic causes between 2009 and 2022 at a cancer referral center. The primary outcomes were the occurrence of major complications at day 90 and the 1-year all-cause mortality. Multivariate logistic regression was used to identify independent predictors.Results:Among the 8503 ICU admissions from surgical wards, 204 splenectomies were performed; 179 patients were analyzed. The median age was 64 years, and 100 patients (55.9%) were female. Splenectomy was performed for hematologic malignancies in 76 cases (42.5%) and for oncologic causes in 103 cases (57.5%). Laparotomy was used in 154 cases (86.0%), and metastasectomy was performed in 54 patients (30.2%). At day 90, 86 patients (48.0%) developed a major complication: 12 deaths (6.7%), 44 surgical complications (24.6%), and 71 episodes of sepsis (39.7%). In a multivariate analysis, weight loss (OR 3.39, 95% CI [1.32–8.70],p= 0.011), laparotomy (OR 4.38 [1.09–17.60],p= 0.038), and a higher SAPS II score (OR 1.08 per point [1.03–1.13],p= 0.003) were associated with complications, while metastasectomy was protective (OR 0.23 [0.08–0.67],p= 0.007). At one year, the mortality reached 22.4%. Independent predictors of death were sepsis at one year (OR 5.04, 95% CI [1.30–25.96],p= 0.029), the Charlson Comorbidity Index (OR 1.30 per point, 95% CI [1.04–1.68],p= 0.030), invasive mechanical ventilation (OR 14.94, 95% CI [2.83–118.93],p= 0.003), and a performance status >1 (OR 7.84, 95% CI [2.38–27.75],p< 0.001). Encapsulated bacteria were not isolated; sepsis was mainly due to Gram-negative and enterococcal organisms.Conclusions: Splenectomy in onco-hematologic patients is associated with high rates of sepsis and mortality. In addition to surgical factors, frailty, immune status, and infection independently contribute to the patients’ outcomes. These results support risk-adapted perioperative strategies and long-term infectious surveillance in immunocompromised patients.
背景：脾切除术在特定肿瘤及血液病适应症中仍有必要，但伴随显著的术后并发症发生率和死亡率。目前针对这一高风险人群结局的数据仍有限，尤其在混合队列研究中更为明显。 方法：我们开展了一项回顾性队列研究，纳入2009年至2022年间在某癌症转诊中心因肿瘤或血液病原因接受脾切除术的所有患者。主要结局指标为术后90天内主要并发症发生率及1年全因死亡率。采用多因素逻辑回归分析确定独立预测因素。 结果：在8503例外科病房转入ICU的患者中，共实施204例脾切除术；最终179例患者纳入分析。中位年龄64岁，女性100例（55.9%）。因血液系统恶性肿瘤行脾切除术76例（42.5%），因肿瘤原因103例（57.5%）。154例（86.0%）采用开腹手术，54例（30.2%）同期实施转移灶切除术。术后90天内，86例患者（48.0%）发生主要并发症：包括死亡12例（6.7%）、手术并发症44例（24.6%）和脓毒症发作71例（39.7%）。多因素分析显示，体重减轻（OR 3.39，95% CI [1.32–8.70]，p=0.011）、开腹手术（OR 4.38 [1.09–17.60]，p=0.038）及较高SAPS II评分（每增加1分OR 1.08 [1.03–1.13]，p=0.003）与并发症发生相关，而转移灶切除术具有保护作用（OR 0.23 [0.08–0.67]，p=0.007）。一年死亡率达22.4%。死亡的独立预测因素包括：一年内发生脓毒症（OR 5.04，95% CI [1.30–25.96]，p=0.029）、查尔森合并症指数（每增加1分OR 1.30，95% CI [1.04–1.68]，p=0.030）、有创机械通气（OR 14.94，95% CI [2.83–118.93]，p=0.003）及体能状态>1级（OR 7.84，95% CI [2.38–27.75]，p<0.001）。未分离出荚膜细菌；脓毒症主要源于革兰阴性菌和肠球菌感染。 结论：肿瘤血液病患者的脾切除术与高发的脓毒症和死亡率相关。除手术因素外，患者衰弱程度、免疫状态及感染情况均独立影响临床结局。这些结果支持对免疫功能低下患者采取风险适应的围术期策略及长期感染监测。
肿瘤(癌症)患者之家