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Splenectomy in cancer surgery: diminishing indications?

The diminishing enthusiasm towards performing splenectomy (SPL) either as an integral part of surgical cancer management (SCM), or for staging/management (ST) of lymphoma, warranted our assessment of the extent of this trend in a minority population. We retrospectively analysed all SPL submitted to Surgical Pathology for histological processing over a 24-year period (1/1/70-12/31/93) at the Howard University Hospital, a predominantly African-American institution. Of the 446 SPL performed during the period, sixty-nine (15.5%) were performed as part of SCM/ST. Seventy-five per cent (52/69) were for solid intra-abdominal cancers (SIC) and 25% (17/69) for lymphoma. As a group, the patients were older, 71% over 40 years old) and showed a male predominance (61% males). Sixty-two per cent (43/69) of the SPL were performed in the decade 1970-1979. In the following decade 1980-1989, the frequency with which SPL was performed, had dropped to 33% (23/69). Four years into the current decade, 1990-1993, only 5% (3/69) of the SPL were performed for SCM/ST. These findings suggest that in African-Americans, the performance of SPL in ST/SCM has been declining over the years, which is in agreement with the current growing trends in cancer treatment i.e. to avoid unnecessary operations, limit morbidity, preserve important organs, maintain immunocompetence of the patient and to utilize advanced imaging techniques in ST/SCM.