Introduction/Background Splenectomy is performed in ovarian cytoreductive surgery when either pre-operative imaging or intra-operative examination suggests disease involvement.

Methodology We conducted a single institution retrospective review to assess rates of splenectomy, accuracy of imaging and intra-operative assessment, peri-operative complications and patient compliance with prophylactic antimicrobial therapy and immunizations.

Results Over a period of 7 years (2015 - 2022), 469 cytoreductive surgeries for FIGO stage III-IV epithelial ovarian cancer were undertaken. A splenectomy was performed in 61 (13%) patients. Complete cytoreduction was achieved in 96.7% of patients undergoing a splenectomy. Thirty-two splenectomies (52.4%) were performed by a gynaecological oncologist and 29 (47.6%) by a general surgeon.

On pre-operative imaging assessment, 36 patients (59%) had suspicion for splenic disease and a further 15 (24.5%) patients had malignancy suspected at intraoperative assessment. Postoperative pathology confirmed splenic disease in 49 (80.3%) patients. In 5 patients (8.1%), the spleen was removed due to omental disease inseparable from the spleen. Final pathology showed that the spleen was negative for disease in 4 patients (6.5%). In 3 (4.9%) patients a splenectomy was performed due to intraoperative trauma. There were no cases of post-operative pancreatic fistula and 15 cases (24.5%) of biochemical leak without clinical significance.

Remaining living patients were audited for adherence to recommended post operative management. 16/18 patients (88.9%) had received recommended vaccinations between 2–6 weeks post-surgery, and 17/18 (94%) consistently continued ongoing vaccinations. Additionally, 16 (88.9%) adhered to prescribed daily prophylactic antibiotics.

Conclusion Splenectomy, integral to ovarian cytoreduction, facilitates high rates of complete cytoreduction. Preoperative and intraoperative assessments can predict accurately the existence of malignancy in spleen, confirmed by pathology. Traumatic cases were minimal (3/469). Emphasizing a well-defined splenectomy protocol is crucial, ensuring adherence to mitigate post-splenectomy complications.

Disclosures Mr Ioannis Kotsopoulos:

1. Cost cover for HIPEC training by RanD

2. Cost cover for Robotic surgery training by Intuitive

3. Employed by HCA Healthcare UK for my private practice

fort other co-authors, no disclosure form.