Splenectomy during primary and secondary cytoreductive surgery for epithelial ovarian carcinoma

Splenectomy is occasionally indicated to achieve optimal cytoreduction during surgery for epithelial ovarian cancer. Between January 1989 and December 1996, 40 epithelial ovarian cancer patients underwent splenectomy: 14 patients during primary surgery and 26 during secondary cytoreductive surgery. Splenectomy was performed for tumor reduction in 34 patients (85%) and for iatrogenic injury in six patients (15%). The spleen was removed because of parenchymal splenic metastases in nine patients (22.5%), significant hilar and/or capsular disease in 10 patients (25%), and perisplenic disease in 15 patients (37.5%). The histopathological diagnosis of the resected spleens showed microscopic hilar disease in four patients who had the spleen removed because of iatrogenic injury and no disease in only two patients. Splenectomy could be carried out with an acceptable morbidity. Left-sided pleural effusion was the most frequent complication. The estimated two-year survival rate for patients who underwent splenectomy during primary surgery with no residual disease and <2 cm intraperitoneal residual disease was 83% and 42%, respectively. Nine of these patients (64.3%) had recurrent disease. The median time to recurrence was 11 months (range 5-18). The estimated two-year survival rate for patients who underwent splenectomy during secondary surgery with no residual disease and <2 cm intraperitoneal residual disease was 78% and 24%, respectively. The estimated three-year survival rate was 0% for all these patients. The results of the present study show that splenectomy, if necessary to achieve optimal debulking, should be considered in previously untreated patients with no intraperitoneal residual disease and in patients with late (>1 year) recurrent disease.