Evrim Erdemoglu, Hanna J Schaeffeler, Paul M Magtibay, Javier F Magrina, Kristina A Butler
In this highly selected cohort treated at a tertiary referral center, MIS splenectomy appeared technically feasible and short-term safe and was associated with favorable observed oncologic outcomes. These findings support feasibility but do not establish causal oncologic efficacy.
STUDY OBJECTIVE: To evaluate the surgical safety, feasibility, and long-term oncologic outcomes of minimally invasive (MIS) splenectomy in patients with isolated or oligometastatic recurrence of gynecologic malignancies.
DESIGN: Retrospective single-institution cohort study (AAGL Classification of Evidence: II-3).
SETTING: Tertiary academic referral center (Mayo Clinic, Arizona, USA).
PATIENTS: Ten consecutive women with platinum-sensitive recurrent gynecologic cancer (6 ovarian, 2 endometrial, 2 cervical) involving the spleen or left upper quadrant. Eight patients had pathologically confirmed recurrent gynecologic malignancy; in 2, pathology revealed non-gynecologic disease (necrotizing granuloma; B-cell lymphoma). The primary oncologic analysis was restricted to the 8 confirmed cases.
INTERVENTIONS: MIS splenectomy (laparoscopic, n=6; robotic, n=4) for secondary or tertiary cytoreduction, with concomitant procedures when needed for complete resection.
MEASUREMENTS AND MAIN RESULTS: All procedures were completed minimally invasively without conversion. Median operative time was 202 minutes (IQR 196.5-211.5; range 108-325) and median estimated blood loss was 50 mL (IQR 50-125; range 20-450). No intraoperative complications occurred. Postoperative complications were limited to Clavien-Dindo grade I-II; median Comprehensive Complication Index was 11.2. Median hospital stay was 42 hours (IQR 25.5-72.25). R0 resection was achieved in 10/10 patients (100%). In the primary analysis (n=8), at a median follow-up of 53.8 months after splenectomy, one patient developed recurrence at 78.5 months and no patient had died; five-year overall survival and five-year disease-free survival were both 100% (exact 95% CI 39.8-100%). Survival estimates should be interpreted cautiously given the small sample size.
CONCLUSION: In this highly selected cohort treated at a tertiary referral center, MIS splenectomy appeared technically feasible and short-term safe and was associated with favorable observed oncologic outcomes. These findings support feasibility but do not establish causal oncologic efficacy.