Lenfoproliferatif hastalıklarda splenektomi endikasyonları ve klinik sonuçlarımız

Yıl 2021, Cilt: 12 Sayı: 1, 102 - 106, 31.03.2021

Ramazan Sarı , Mehmet Zeki Buldanlı

https://doi.org/10.18663/tjcl.822973

Öz

Amaç: Hematolojik malignitelerde sistemik tutulum nedeniyle cerrahinin faydası oldukça sınırlıdır. Splenektomi özellikle izole dalak lenfomalarında kimi zaman hem tanı hem de tedavi amaçlı gerekir. Bu çalışmanın amacı lenfoma tanısıyla takip edilen hastalarda splenektominin endikasyon ve yararlarını incelemek, operasyon sonrasındaki klinik sonuçlarımızı tartışmaktır.
Gereç ve Yöntemler: Çalışmamıza Ocak 2012 ve Aralık 2019 tarihleri arasında lenfoid malignite nedeniyle hematoloji bölümünce takip edilen ve splenektomi endikasyonuyla tarafımıza yönlendirilen hastalar dahil edildi. Hastalara ait demografik ve klinik veriler ile tedavi sonuçları geriye dönük olarak incelendi.
Bulgular: Çalışmaya toplam 44 hasta dahil edildi. Hastaların splenektomi zamanındaki yaş ortalaması 58,2 (±12.4) idi. Hastaların %63,6’sı erkekti. Splenektomi sonrası ortalama takip süresi 12,3 (3-94) aydı. 26 hasta semptomatik splenomegali, 18 hasta medikal tedaviyle düzeltilemeyen trombositopeni ve anemi gibi endikasyonlarla opere edildi. Tedavi sonrası klinik iyileşme splenik marjinal zon lenfomasında diğer lenfoma tiplerine göre daha yüksekti.
Sonuç: Son yıllarda özellikle monoklonal antikorlarla yapılan medikal tedaviler sayesinde lenfoma tedavisinde cerrahi ihtiyacı giderek azalmaktadır. Verilerimiz dalak tutulumu olan lenfoid malignitelerde ve özellikle splenik marjinal zon lenfomasında splenektominin etkili ve güvenli bir tedavi seçeneği olduğunu göstermektedir.

Anahtar Kelimeler

lenfoma, marjinal zon lenfoma, splenektomi

Splenectomy indications and clinical results in lymphoproliferative diseases

Öz

Aim: The benefits of surgery are very limited in hematological malignancies due to systemic involvement. Splenectomy is sometimes required for both diagnosis and treatment, especially in isolated splenic lymphomas. The aim of this study is to examine the indications and benefits of splenectomy in patients with lymphoma diagnosis and to discuss our postoperative clinical results.
Material and Methods: Patients who were followed up by the hematology department for lymphoid malignancy between January 2012 and December 2019 and referred to us with the indication of splenectomy were included in our study. The demographic and clinical data of the patients and the treatment results were analyzed retrospectively.
Results: A total of 44 patients were included in the study. The mean age of the patients at the time of splenectomy was 58.2 (± 12.4). Sixty three percent of the patients were male. The mean follow-up time after splenectomy was 12.3 (3-94) months. Twenty six patients were operated due to symptomatic splenomegaly, 18 patients were operated due to thrombocytopenia and anemia that could not be corrected by medical therapy. Clinical improvement after treatment was higher in splenic marginal zone lymphoma than in other types of lymphoma.
Conclusion: In recent years, the need for surgery in the treatment of lymphoma has been decreasing, especially through medical treatments with monoclonal antibodies. Our data show that splenectomy is an effective and safe treatment option in lymphoid malignancies and especially in splenic marginal zone lymphoma.

Anahtar Kelimeler

lymphoma, marginal zone lymphoma, splenectomy

Kaynakça

• 1- Bonnet S, Guedon A, Ribeil J-A, Suarez F, Tamburini J, Gaujoux S. Indications and outcome of splenectomy in hematologic disease. Journal of visceral surgery. 2017; 154(6): 421-9
• 2- Ciftciler R, Pasayeva A, Aksu S, et al. Indications and Outcomes of Splenectomy for Hematological Disorders. Open Med (Wars). 2019; 14: 491-6.
• 3- Tokue H, Hirasawa S, Morita H, et al. Percutaneous image-guided biopsy for non-mass-forming isolated splenomegaly and suspected malignant lymphoma. PLoS One. 2014; 9(11): e111657.
• 4- Onisâi M, Vlădăreanu AM, Nica A, et al. Splenectomy in Lymphoproliferative Disorders: A Single Eastern European Center Experience. Medicina (Kaunas). 2019. 27; 56(1): 12.
• 5- Uranüs S, Dorr K. Laparoscopy in Abdominal Trauma. Eur J Trauma Emerg Surg. 2010; 36(1): 19-24.
• 6- Habermalz B, Sauerland S, Decker G, et al. Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2008; 22(4): 821-48.
• 7- Alobuia WM, Perrone K, Iberri DJ, Brar RS, Spain DA, Forrester JD. Splenectomy for benign and malignant hematologic pathology: Modern morbidity, mortality, and long-term outcomes. Surg Open Sci. 2020: 16; 2(4): 19-24.
• 8- Swerdlow SH, Campo E, Harris NL, et al, eds. WHO Classification of Tumors of the Haematopoietic and Lymphoid Tissues. IARC Press; 2017.
• 9- Rodgers, G. Thrombocytopenia: Pathophysiology and classification. In Wintrobe’s Clinical Haematology, 12th ed.; Greer, J., Foerster, J., Lukens, J., Rodgers, G., Paraskevas, F., Glader, B., Eds.; Lippincott Williams & Wilkins: Philadelphia, PA, USA, 2009; pp. 1289–91.
• 10- Kalpadakis, C, Pangalis GA, Vassilakopoulos, TP, Sachanas S, Angelopoulou MK. Treatment of splenic marginal zone lymphoma: should splenectomy be abandoned? Leukemia & Lymphoma. 2013; 55: 1463–70.
• 11- Bennett M, Schechter GP. Treatment of splenic marginal zone lymphoma: splenectomy versus rituximab. Semin Hematol. 2010; 47(2): 143-7.
• 12- Lenglet J, Traullé C, Mounier N, et al. Long-term follow-up analysis of 100 patients with splenic marginal zone lymphoma treated with splenectomy as first-line treatment. Leuk Lymphoma. 2014; 55(8): 1854-60.
• 13- Cadiere B, Grilli A, Bron D. Comparison of Laparoscopic Splenectomy Outcomes for Benign and Malignant Hemopathies. J Laparoendosc Adv Surg Tech A. 2020; 30(11): 1172-6.
• 14- Bagrodia N, Button AM, Spanheimer PM, Belding-Schmitt ME, Rosenstein LJ, Mezhir JJ. Morbidity and Mortality Following Elective Splenectomy for Benign and Malignant Hematologic Conditions: Analysis of the American College of Surgeons National Surgical Quality Improvement Program Data. JAMA Surg. 2014;149(10):1022–1029.
• 15- Musallam KM, KhalifeM, Sfeir PM, et al. Postoperative outcomes after laparoscopic splenectomy compared with open splenectomy. Ann Surg. 2013;257(6):1116-1123.
• 16- Winslow ER, Brunt LM. Perioperative outcomes of laparoscopic versus open splenectomy: a meta-analysis with an emphasis on complications. Surgery. 2003; 134(4): 647-53; discussion 654-5.
• 17- Rosen M, Brody F, Walsh RM, Tarnoff M, Malm J, Ponsky J. Outcome of laparoscopic splenectomy based on hematologic indication. Surg Endosc. 2002; 16(2): 272-9.
• 18- Balague C, Targarona EM, Cerdan G, et al. Long-term outcome after laparoscopic splenectomy related to hematological diagnosis. Surg Endosc 2004; 18:1283–7.
• 19- Thomsen RW, Schoonen WM, Farkas DK, Riis A, Fryzek JP, Sørensen HT. Risk of venous thromboembolism in splenectomized patients compared with the general population and appendectomized patients: a 10-year nationwide cohort study. J Thromb Haemost. 2010; 8(6): 1413-6.
• 20- Taner T, Nagorney DM, Tefferi A, et al. Splenectomy for massive splenomegaly: long-term results and risks for mortality. Ann Surg. 2013; 258(6): 1034-9.
• 21- Berenguer CM, Ochsner MG Jr, Lord SA, Senkowski CK. Improving surgical site infections: using National Surgical Quality Improvement Program data to institute Surgical Care Improvement Project protocols in improving surgical outcomes. J Am Coll Surg. 2010 May;210(5):737-41, 741-3.
• 22- Bernard AC, Davenport DL, Chang PK, Vaughan TB, Zwischenberger JB. Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients. J Am Coll Surg. 2009 May;208(5):931-7, 937.e1-2; discussion 938-9.