Objective: Esophageal cancer surgery carries a risk of splenic injury, which may require splenectomy, but predictors of such events remain uncertain. Moreover, the hypothesis that incidental splenectomy carries a worse prognosis deserves attention.
Design: A population-based, nationwide cohort study was conducted on 1679 patients who underwent resection for esophageal cancer in Sweden in 1987 to 2010, with follow-up until February 2012. Predictors of splenic injury and incidental splenectomy were analyzed using multivariable logistic regression, providing odds ratios (ORs) with 95% confidence intervals (CIs). Associations between incidental splenectomy and risk of mortality and severe infections were analyzed using multivariable Cox regression, providing hazard ratios (HRs) with 95% CIs.
Results: Higher surgeon volume of esophageal cancer resection decreased the risk of splenic injury and incidental splenectomy (OR: 0.58; 95% CI: 0.41–0.80; and OR: 0.41; 95% CI: 0.25–0.66, respectively, comparing the highest to lowest category). In patients with splenic injury, progression to incidental splenectomy decreased by 92% during the study period. Sex, age, tumor stage, previous abdominal surgery, neoadjuvant therapy, and surgical radicality did not influence these risks. Incidental accidental splenectomy increased the overall risk of mortality (HR: 1.29; 95% CI: 1.03–1.61) and severe infections (HR: 2.79; 95% CI: 1.35–5.79).
Conclusion: The inverse association between surgeon volume and splenic injury supports centralization of esophageal cancer surgery. The increased risk of mortality and severe infections after incidental splenectomy should be kept in mind during surgery, and we should encourage efforts to preserve an injured spleen and stress the relevance of vaccination after splenectomy.
Esophageal cancer surgery carries a risk of splenic injury and incidental splenectomy. In this large population-based cohort we assessed risk factors for splenic injury and incidental splenectomy and we further assessed the association of incidental splenectomy and mortality and risk of severe infections after esophageal cancer surgery.
*Surgical Care Sciences, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
†Upper GI Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
‡Division of Cancer Studies, King's College London, London, United Kingdom.
Reprints: Maryam Derogar, MD, PhD, Unit of Upper Gastrointestinal Research, Karolinska Institutet, NS 67, Level 2, 171 76 Stockholm, Sweden. E-mail: firstname.lastname@example.org.
Supported by the Swedish Research Council (SIMSAM), the Swedish Cancer Society, and the Robert Lundberg Memorial Foundation.
Disclosure: The authors declare no conflicts of interest.
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