Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA.
Int J Gynecol Cancer. 2020 Aug;30(8):1183-1188. doi: 10.1136/ijgc-2020-001368. Epub 2020 Jul 13.
The spleen plays a role in the immune and coagulative responses, yet a splenectomy may be required during ovarian cancer surgery to achieve complete cytoreduction. The aim of the study was to correlate hematologic changes with the development of infection and venous thromboembolism in patients undergoing splenectomy.
This single-institution retrospective review includes all patients undergoing splenectomy during cytoreductive surgery for advanced ovarian cancer, March 2001 to December 2016. We compared postoperative hematologic changes (evaluated daily before discharge) in patients developing infection within 30 days' post-surgery (Infection group) with those who did not (No-Infection group). We also compared patients developing venous thromboembolism with those without.
A total of 265 patients underwent splenectomy. Median age was 64 years (range 22-88): 146 (55%) patients had stage IIIC and 114 (43%) patients had stage IV. The majority, 201 (76%) patients underwent splenectomy during primary debulking. A total of 132 (50%) patients comprised the Infection group (most common: urinary tract infection, 54%). Median time from surgery to infection was 8 days (range, 0-29). After initial rise in white blood cell count in both groups, the Infection group had a second peak on postoperative day 10 (median 16.6K/mcL, IQR 12.5-21.2) not seen in the No-Infection group (median 12K/mcL, IQR 9.3-16.3). A total of 40 (15%) patients developed venous thromboembolism, median time of 6.5 days (range, 1-43). All patients demonstrated a continuous rise in platelets during postoperative days 0-15. Thrombocytosis was present in 38/40 (95%) patients with venous thromboembolism vs 183/225 (81%) patients without (P=0.036). Median days with thrombocytosis was higher in venous thromboembolism (8 days, range 1-15) vs non groups (6 days, range 1-16, P=0.049).
We identified initial leukocytosis after splenectomy in all patients. The Infection group had a second peak in white blood cell count on postoperative day 10, not present in the No-Infection group. Among patients with venous thromboembolism, thrombocytosis was more frequent and of longer duration.
脾脏在免疫和凝血反应中发挥作用，但在卵巢癌手术中可能需要进行脾切除术以实现完全减瘤。本研究的目的是在接受脾切除术的患者中，将血液学变化与感染和静脉血栓栓塞的发生相关联。
这是一项单中心回顾性研究，纳入了 2001 年 3 月至 2016 年 12 月期间在卵巢癌减瘤术过程中接受脾切除术的所有患者。我们比较了术后 30 天内发生感染的患者（感染组）与未发生感染的患者（无感染组）的术后血液学变化（在出院前每天评估）。我们还比较了发生静脉血栓栓塞的患者与未发生的患者。
共 265 例患者接受了脾切除术。中位年龄为 64 岁（范围 22-88）：146 例（55%）患者为 IIIC 期，114 例（43%）患者为 IV 期。大多数患者（76%，201 例）在初次减瘤术中接受了脾切除术。共有 132 例（50%）患者构成感染组（最常见的是尿路感染，54%）。从手术到感染的中位时间为 8 天（范围，0-29）。两组的白细胞计数最初升高后，感染组在术后第 10 天（中位数 16.6K/mcL，IQR 12.5-21.2）出现第二次高峰，而无感染组则未出现（中位数 12K/mcL，IQR 9.3-16.3）。共有 40 例（15%）患者发生静脉血栓栓塞，中位时间为 6.5 天（范围，1-43）。所有患者在术后 0-15 天血小板持续升高。静脉血栓栓塞组中血小板增多症的发生率为 38/40（95%），而非静脉血栓栓塞组为 183/225（81%）（P=0.036）。静脉血栓栓塞组血小板增多症的中位天数较高（8 天，范围 1-15），而非静脉血栓栓塞组（6 天，范围 1-16，P=0.049）。
我们发现所有患者在脾切除术后均出现初始白细胞增多。感染组在术后第 10 天出现第二次白细胞计数高峰，而非感染组则未出现。在发生静脉血栓栓塞的患者中，血小板增多症更为常见且持续时间更长。
