The significance of inadvertent splenectomy during colorectal cancer resection

Objective: To examine the frequency, predictors, and outcomes following inadvertent splenectomy during colorectal cancer resection. Design: Retrospective study. Setting: Linkage of the California Cancer Registry and the California Patient Discharge Database from the Office of Statewide Health Planning and Development. Participants: Californians undergoing colorectal cancer resection from 1995 through 2001. Inadvertent splenectomy was defined as splenectomy occurring during non-T4 or non-stage IV resection. Main Outcome Measure: The rate of inadvertent splenectomy for the overall cohort and by tumor location (eg, splenic flexure, rectosigmoid). Multivariate risk-adjusted models identified predictors of inadvertent splenectomy and outcomes including length of stay and probability of death. Results: A total of 41 999 non-T4, non-stage IV colorectal cancer resections were studied. Mean age was 70.4 years; 50.4% were male; and 75.6% were non-Hispanic white. Although the overall rate of inadvertent splenectomy was less than 1%, the rate was 6% for splenic flexure tumors. A multivariate risk-adjusted model predicting inadvertent splenectomy demonstrated a statistically significant (P < .001) higher odds ratio if the tumor was located in the transverse (3.6), splenic flexure (29.2), descending (11.4), sigmoid (2.7), or rectosigmoid (2.6) regions. Using a risk-adjusted model, inadvertent splenectomy increased length of stay by 37.4% (P < .001). Perhaps most important, risk-adjusted survival analysis showed splenectomy increased the probability of death by 40% (P < .001). Conclusions: To our knowledge, this is the first large study evaluating the rates and outcomes after inadvertent splenectomy. In the population-based cohort, tumor locations from the transverse colon to the rectosigmoid significantly increased the odds of inadvertent splenectomy. In addition, inadvertent splenectomy during colorectal cancer resection increased both length of stay and probability of death.