A 10‐year experience with splenectomy in patients with malignant non‐Hodgkin's lymphoma at the Norwegian Radium Hospital

Abstract

Background. Splenectomy is a major surgical intervention that has many implications for patients with malignant non‐Hodgkin's lymphoma. As debated during the last few decades, the therapeutic benefit must outweigh the surgical risk and the loss of cellular immunity. A more liberal attitude toward splenectomy developed during the years 1980‐1990 at the Norwegian Radium Hospital, as illustrated by the higher number of operations performed in the last 5 years (21 patients) compared to the first 5 years (14 patients). Methods. A 10‐year retrospective review of the effects and side effects of splenectomy in 35 patients with malignant non‐Hodgkin's lymphoma was performed, based on information obtained from the patient files at the authors' institution. Results. Clinical Stage IV disease was found in 29 patients (83%), and B symptoms in 15 patients (43%). At diagnosis, 26 patients (74%) had splenomegaly, and 8 patients (23%) had primary splenic lymphoma. The surgical mortality was 2.9%, and the morbidity was 37%. Infection was the most common complication, occurring in seven patients (20%). Pneumococcal vaccination had been performed in 13 patients, and the frequency of septicemia and pneumonia tended to be higher during follow‐up in unvaccinated patients (not significant). Blood counts returned to normal during the first postoperative month in 18 of 25 patients (72%) who had cytopenia. After splenectomy, a durable remission was acheived in five patients (14%) who did not receive subsequent treatment. Conclusions. Splenectomy has the potential to relieve local symptoms, correct cytopenias, and modify the disease course in patients with malignant non‐Hodgkin's lymphomas, even in advanced stages, at the cost of an acceptable operative risk. Copyright © 1994 American Cancer Society