Dr. Cadili Work

Dr. Cadili Work on Complications with Splenectomy

Dr. Cadili

Dr. Cadili

Dr. Cadili
Removal of the spleen, or a splenectomy, is associated with a variety of complications, Dr. Cadili explains this in depth with us
What is Splenectomy?
splenectomy

splenectomy

Surgical removal of the spleen, known as a splenectomy, is a procedure that has rapidly decreased in frequency. The popularity shift is due to our understanding of the complications of the asplenic state. However, the full spectrum and details of the splenic function are not yet fully understood. As a result, the long-term consequences of splenectomy is incomplete. Dr. Cadili has reviewed various evidence that related to the effects of splenectomy on infection, malignancy, thrombosis, and transplantation. The most commonly understood complication of splenectomy is the patient's susceptibility to infection. Due to this concern, techniques have been developed in an attempt to keep splenic function in patients who require splenic surgery. Dr. Cadili reviews the efficiency of the methods developed in terms of maintaining splenic function and fewer complications associated with splenectomy.
Splenectomy and Infection
Asplenia is linked to making patients more susceptible to infection. The most significant and specific complication is an overwhelming post-splenectomy infection. The risk of overwhelming post-splenectomy infection is increased with younger age, and reduced time interval. The risk of infection is higher in the first two years after splenectomy, but patients are still at a lifetime risk of developing infection. However, there are some methods that have proven effective in preventing overwhelming post-splenectomy infection. These methods include; patient education, prophylactic antibiotics, and vaccination, according to Dr. Cadili.
Splenectomy and Malignancy
One common question concerning asplenia is whether or not is predisposes one to increased cancer growth or recurrence. Numerous experimental studies in animals have examined the role of splenectomy on tumor growth and progression. Generally, these studies have provided support for some part of splenectomy in carcinogenesis. Many of these studies have affirmed a time-sensitive effect of splenectomy on tumor growth but have yielded conflicting results on the exact nature of this effect. Some have demonstrated accelerated tumor growth when splenectomy is performed late after tumor transplantation and retarded growth when it is performed before early after tumor transplantation. One can conclude from other studies, and evidence gathered thus far, that splenectomy for trauma does not seem to increase the risk of cancer, whereas splenectomy for other reasons may or may not increase that risk. Moreover, the mechanisms by which the spleen, or lack thereof, may influence tumor development or growth are yet to be proven, says Dr. Cadili.
Splenectomy and Transplantation
The effect that splenectomy may, or may not, have on transplant rejection or success has also been examined by multiple other studies, according to Dr. Cadili. Although, human experiments are still lacking and most have occured on animals. A review of renal transplant recipients showed improved initial but not long-term graft survival and no difference in overall survival between splenectomized and non-splenectomized patients. A recent small case series reported a dramatic effect of urgent splenectomy on renal transplants that were undergoing acute rejection. Hematopoietic stem cell transplantation is a therapy that is used to treat patients with various hematologic diseases, such as multiple myeloma and lymphoma. Patients with preexisting hypersplenism, often related to their underlying condition, experience diminished engraftment. These patients show improved engraftment when splenectomy is performed before transplantation. This study also provided indirect evidence for the efficacy of partial splenectomy in relieving hypersplenism. Some evidence, however, particularly from animal experiments, suggests that splenectomy may improve the success of transplantation, convincing evidence of significant benefit in humans is still lacking. The exception to this is cases of preexisting hypersplenism that is adversely affecting engraftment. The subject needs to be studied in greater length and detail before any conclusions can be made.
Splenectomy and Thrombosis
Portal vein thrombosis is a well-recognized complication of splenectomy, says Dr. Cadili. Increases in accuracy and frequency of imaging studies have led to the rise in the detection of portal vein thrombosis. Variability among studied concerning the underlying disease, timing of follow-up, and imaging used for detection has made firm conclusions on the causes and incidence of this complication difficult. Evidence supports the notion that the risk of postoperative portal vein thrombosis depends on the underlying condition for which the splenectomy is being performed. Patients with myeloproliferative disorders have been found to sustain higher rates of post-splenectomy portal vein thrombosis than others. Another compounding factor is that many patients presumed to be undergoing splenectomy for the non-hematologic disease are ultimately found to have a systemic thrombotic disorder. No clear association between thrombocytosis, a frequent consequence of splenectomy, and portal vein thrombosis have been found. Current evidence suggests that postoperative low molecular weight heparin alone is insufficient for this purpose. A combination of postoperative heparin, possibly warfarin, and antiplatelet agents may prove more efficacious but has not been validated.
Conclusions to be Made About Splenectomy
The risks of postoperative infection and thrombosis after splenectomy are now widely accepted among medical professionals. In contrast, the effects of splenectomy on malignancy and transplantation have been less well characterized and require further study. The role of alternatives to total splenectomy (that aim to maintain splenic function), such as partial splenectomy and splenic autotransplantation, in post-splenectomy complications are not yet known. According to Dr. Cadili, our knowledge of the consequences of the asplenic state is still in infancy and will be the subject of ongoing investigations for many years to come.

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