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Abstract
Introduction/Background*Epithelial ovarian cancer (EOC) patients undergoing splenectomy during cytoreductive surgery represent a small subgroup of patients. Splenic metastases or technical reasons due to extensive upper abdominal disease may require a splenectomy. However, there is limited knowledge on the impact of splenectomy on the long-term outcome of patients. Particularly, it has been hypothesized that as the antitumor immunologic functions of the spleen may inhibit cancer growth, splenectomy may promote the growth of residual disease during the postoperative period as observed in murine models of other cancer types [3-6]. The aim of this study was to assess the effect of a splenectomy during cytoreductive surgery on perioperative outcomes and survival of advanced stage EOC patients.
Methodology In this nationwide population-based study, all consecutive patients diagnosed with FIGO stage IIIC and IV EOC between 01-01-2008 and 31-12-2015 were identified from the Netherlands Cancer Registry. Patients who underwent cytoreductive surgery combined with platinum-based chemotherapy as primary treatment were selected. Differences in clinicopathological characteristics between splenectomy and non-splenectomy patients were assessed. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier survival curves and log-rank tests. Cox proportional hazards models were used to adjust for covariates that influence survival.
Result(s)*A total of 3,911 patients were identified, including 99 splenectomy and 3,812 non-splenectomy patients. Splenectomy patients were more likely to undergo extensive surgery or surgical reintervention, to receive intraperitoneal chemotherapy, intraoperative and postoperative blood transfusion, to experience postoperative infections, and to be admitted to Intensive Care Unit (all p<0.002). No significant differences in PFS and OS were observed between splenectomy versus non-splenectomy patients after adjusting for covariates.
Kaplan-Meier estimates of the progression-free survival (PFS) of non-splenectomy patients (N = 3,654, dash line) and splenectomy patients (N = 94, solid line). The median PFS in months were 16 and 18 months for the non-splenectomy and splenectomy patients, respectively. No significant difference in PFS was observed with the log-rank test (p = 0.477).
*An additional 163 patients were excluded from the survival analysis with reference to figure 1, since these patients had unknown follow-up or survival data.
Kaplan-Meier estimates of the overall survival (OS) of non-splenectomy patients (N = 3,803, dash line) and splenectomy patients (N = 98, solid line). The median OS in months was 36 months for both the non-splenectomy and splenectomy patients. No significant difference in OS was observed with the log-rank test (p = 0.306).
*An additional 10 patients were excluded from the survival analysis with reference to figure 1, since these patients had unknown follow-up or survival data.
Conclusion*While advanced stage EOC patients who undergo splenectomy during cytoreductive surgery have more extensive disease and undergo intensive treatment, no adverse effect of splenectomy on the survival was observed. Splenectomy during cytoreductive surgery is justified to achieve complete cytoreduction in advanced stage EOC patients.