Long-Term Outcomes After Elective Splenectomy for Haematological Disease: A 27-Year Single-Centre Study.

BACKGROUND: Splenectomy has traditionally been used to treat a range of haematological diseases. Advances in medical therapies and minimally invasive surgery have altered its therapeutic role. This study evaluates evolving indications and outcomes of elective splenectomy in an Australian teaching hospital over a 27-year period. METHODS: Adult patients undergoing elective splenectomy for haematological disease between 1999 and 2025 at a single tertiary institution were identified from medical records. Caseload, demographics, operative approach, complications and follow-up outcomes were assessed either annually or over three 9-year cohorts. Regression and Fisher's exact tests were used for trend analysis. RESULTS: Seventy patients underwent splenectomy. The annualised caseload and cohort patient age decreased significantly over the study period (p = 0.005 and 0.020, respectively). Benign indications accounted for 54% of patients, most commonly immune thrombocytopenia, while lymphoma and myelofibrosis predominated among malignant indications. There was an upward trend for laparoscopic splenectomy over time (p = 0.051), reduced conversion rates (p = 0.189) and a decrease in operative time (p = 0.012). The overall post-operative complication rate was 21.4%, and most were minor. Ninety-day post-operative mortality was zero. The median follow-up was 9.1 years. Long-term survival was primarily influenced by underlying haematologic disease, with most long-term survivors well with normal platelet counts. CONCLUSION: Despite declining referrals in the era of targeted therapies, splenectomy remains a safe and effective treatment option in selected patients. Outcomes are favourable when performed laparoscopically in experienced hands, and long-term follow-up demonstrates sustained haematologic benefit in surviving patients.