Splenectomy to treat splenic lesions: an analysis of 148 cases at a cancer center.

Overview

BACKGROUND AND OBJECTIVES: Solid and cystic splenic masses discovered on imaging studies often pose diagnostic and management dilemmas. This study analyses a large series of splenectomies to identify preoperative factors associated with malignant splenic masses. METHODS: Pathology records at a single institution were reviewed for all splenectomies. Those performed as a component of a larger resection, such as staging or debulking were excluded. Demographic and clinicopathologic factors were obtained. Univariate and multivariate analyses identified factors associated with an increased risk of malignancy. RESULTS: Between 1986 and 2012, 2,743 patients underwent a splenectomy, 148 of which were performed for lesions identified on imaging. The indications were suspicion of malignancy (120, 81%), growth over time (28, 19%), or symptoms (39, 26%). Resected splenic lesions were malignant in 93 patients (63%); the most common pathologies included ovarian cancer (n = 39), melanoma (n = 14), and colorectal cancer (n = 9). On multivariate analysis of clinicopathologic factors, a previous history of cancer was the only independent predictor of malignancy in the splenic lesion (odds ratio 6.3; 95% CI, 2.32-16.97; P = 0.001). CONCLUSION: While the spleen is an uncommon site of metastatic disease, in patients with a history of cancer, splenic masses selected for resection are frequently malignant.