Splenectomy in Ovarian Cancer Cytoreductive Surgery: Pre-operative Prediction of Disease, Peri-operative Outcomes and Post-operative Adherence to Antimicrobial Prophylaxis and Immunisation.

BACKGROUND/AIM: Splenectomy is performed in ovarian cytoreductive surgery when pre-operative imaging and intra-operative examination suggest disease involvement. This study aimed to evaluate the incidence of splenectomy, the diagnostic accuracy of pre-operative imaging and intra-operative assessment, and the associated short- and long-term peri-operative complications.

PATIENTS AND METHODS: We conducted a single institution retrospective study to assess rates of splenectomy, accuracy of imaging and intra-operative assessment, peri-operative complications and patient compliance with prophylactic antimicrobial therapy and immunizations.

RESULTS: Over a period of 8 years (2014-2022), 469 cytoreductive surgeries for International Federation of Obstetrics and Gynaecology (FIGO) stage III-IV epithelial ovarian cancer were undertaken. A splenectomy was performed in 61 (13%) patients. Complete cytoreduction was achieved in 50 cases (82%) undergoing a splenectomy. On pre-operative imaging assessment, splenic disease was suspected in 36 patients (7.7%) and a further 23 (4.9%) patients had malignancy suspected at intraoperative assessment. In five patients (1%), the spleen was removed due to omental disease inseparable from the spleen. In three (0.6%) cases a splenectomy was performed due to intraoperative trauma. Postoperative pathology confirmed splenic disease in 49 (80.3%) patients. A biochemical leak of no clinical significance was identified in 15/61 (24.6%) splenectomy cases, and one case (1.6%) of post-operative pancreatic fistula (POPF) was identified. Remaining living patients were audited for adherence to recommended post-operative management. Seventeen of the eighteen patients (94%) had received recommended vaccinations between 2-6 weeks post-surgery, and 17/18 (94%) consistently continued ongoing vaccinations. Additionally, 16 (88.9%) adhered to prescribed daily prophylactic antibiotics.

CONCLUSION: Splenectomy, integral to ovarian cytoreduction, facilitates high rates of complete cytoreduction. Preoperative and intraoperative assessments can predict the existence of malignancy in the spleen, confirmed by pathology. Traumatic splenectomy was rare. Emphasising adherence to a post-splenectomy protocol is crucial to mitigate post-splenectomy complications such as POPF, which can significantly delay the initiation of chemotherapy.