Putative predictive parameters for the outcome of laparoscopic splenectomy: A multicenter analysis performed on the italian registry of laparoscopic surgery of the spleen

Marco Casaccia, Paolo Torelli, Ambra Pasa, Maria Pia Sormani, Edoardo Rossi

Research output: Contribution to journalArticle

Abstract

Objective: To identify predictive risk factors for conversion to open splenectomy and postoperative complications in patients undergoing elective laparoscopic splenectomy. Background: The laparoscopic approach represents the "gold standard" for splenectomy, but its use in the treatment of splenomegaly and malignant disease is controversial. Factors that influence immediate outcome are clinical, anatomic, and pathologic. Methods: Univariate and multivariate analyses of data from the Italian Registry of Laparoscopic Surgery of the Spleen, a multicenter database supported by 25 referral centers. Analysis of data (1993-2007) was performed on a series of patients (n = 676) undergoing elective laparoscopic splenectomy. Demographic data, the operative indications, the surgical technique applied, and any intra-and/or postoperative complications with respect to the patients were assessed. Records were analyzed retrospectively using the Student t test, the χ test, and logistic regression. Results: Conversion to open splenectomy was necessary in 39 cases (5.8%). Perioperative deaths occurred in 3 cases (0.4%). There were no complications in 560 patients (82.8%), with a mean hospital stay of 5 days (range, 2-54). Overall, morbidity occurred in 116 patients (17.2%). Multivariate analysis found that the body mass index (P = 0.01) and the presence of hematologic malignancy (P <0.001) were independent predictors for intraoperative complications and surgical conversion. Spleen longitudinal diameter (P = 0.001) and surgical conversion (P = 0.001) were independent predictors for the occurrence of postoperative complications. Conclusions: This large multicenter study provides evidence for the significance of predictive risk factors for intra-and postoperative complications in laparoscopic splenic surgery. Besides splenic dimensions, other factors like the patient's habitus and the specific underlying hematologic pathology should be recognized by the surgeon to reduce complications and initiate adequate treatment.

Original languageEnglish
Pages (from-to)287-291
Number of pages5
JournalAnnals of Surgery
Volume251
Issue number2
DOIs
Publication statusPublished - Feb 2010

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Splenectomy
Laparoscopy
Registries
Spleen
Multivariate Analysis
Splenomegaly
Intraoperative Complications
Hematologic Neoplasms
Multicenter Studies
Length of Stay
Body Mass Index
Referral and Consultation
Logistic Models
Demography
Databases
Pathology
Students
Morbidity
Therapeutics

ASJC Scopus subject areas

  • Surgery

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Putative predictive parameters for the outcome of laparoscopic splenectomy : A multicenter analysis performed on the italian registry of laparoscopic surgery of the spleen. / Casaccia, Marco; Torelli, Paolo; Pasa, Ambra; Sormani, Maria Pia; Rossi, Edoardo.

In: Annals of Surgery, Vol. 251, No. 2, 02.2010, p. 287-291.

Research output: Contribution to journalArticle

Casaccia, Marco ; Torelli, Paolo ; Pasa, Ambra ; Sormani, Maria Pia ; Rossi, Edoardo. / Putative predictive parameters for the outcome of laparoscopic splenectomy : A multicenter analysis performed on the italian registry of laparoscopic surgery of the spleen. In: Annals of Surgery. 2010 ; Vol. 251, No. 2. pp. 287-291.
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abstract = "Objective: To identify predictive risk factors for conversion to open splenectomy and postoperative complications in patients undergoing elective laparoscopic splenectomy. Background: The laparoscopic approach represents the {"}gold standard{"} for splenectomy, but its use in the treatment of splenomegaly and malignant disease is controversial. Factors that influence immediate outcome are clinical, anatomic, and pathologic. Methods: Univariate and multivariate analyses of data from the Italian Registry of Laparoscopic Surgery of the Spleen, a multicenter database supported by 25 referral centers. Analysis of data (1993-2007) was performed on a series of patients (n = 676) undergoing elective laparoscopic splenectomy. Demographic data, the operative indications, the surgical technique applied, and any intra-and/or postoperative complications with respect to the patients were assessed. Records were analyzed retrospectively using the Student t test, the χ test, and logistic regression. Results: Conversion to open splenectomy was necessary in 39 cases (5.8{\%}). Perioperative deaths occurred in 3 cases (0.4{\%}). There were no complications in 560 patients (82.8{\%}), with a mean hospital stay of 5 days (range, 2-54). Overall, morbidity occurred in 116 patients (17.2{\%}). Multivariate analysis found that the body mass index (P = 0.01) and the presence of hematologic malignancy (P <0.001) were independent predictors for intraoperative complications and surgical conversion. Spleen longitudinal diameter (P = 0.001) and surgical conversion (P = 0.001) were independent predictors for the occurrence of postoperative complications. Conclusions: This large multicenter study provides evidence for the significance of predictive risk factors for intra-and postoperative complications in laparoscopic splenic surgery. Besides splenic dimensions, other factors like the patient's habitus and the specific underlying hematologic pathology should be recognized by the surgeon to reduce complications and initiate adequate treatment.",
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N2 - Objective: To identify predictive risk factors for conversion to open splenectomy and postoperative complications in patients undergoing elective laparoscopic splenectomy. Background: The laparoscopic approach represents the "gold standard" for splenectomy, but its use in the treatment of splenomegaly and malignant disease is controversial. Factors that influence immediate outcome are clinical, anatomic, and pathologic. Methods: Univariate and multivariate analyses of data from the Italian Registry of Laparoscopic Surgery of the Spleen, a multicenter database supported by 25 referral centers. Analysis of data (1993-2007) was performed on a series of patients (n = 676) undergoing elective laparoscopic splenectomy. Demographic data, the operative indications, the surgical technique applied, and any intra-and/or postoperative complications with respect to the patients were assessed. Records were analyzed retrospectively using the Student t test, the χ test, and logistic regression. Results: Conversion to open splenectomy was necessary in 39 cases (5.8%). Perioperative deaths occurred in 3 cases (0.4%). There were no complications in 560 patients (82.8%), with a mean hospital stay of 5 days (range, 2-54). Overall, morbidity occurred in 116 patients (17.2%). Multivariate analysis found that the body mass index (P = 0.01) and the presence of hematologic malignancy (P <0.001) were independent predictors for intraoperative complications and surgical conversion. Spleen longitudinal diameter (P = 0.001) and surgical conversion (P = 0.001) were independent predictors for the occurrence of postoperative complications. Conclusions: This large multicenter study provides evidence for the significance of predictive risk factors for intra-and postoperative complications in laparoscopic splenic surgery. Besides splenic dimensions, other factors like the patient's habitus and the specific underlying hematologic pathology should be recognized by the surgeon to reduce complications and initiate adequate treatment.

AB - Objective: To identify predictive risk factors for conversion to open splenectomy and postoperative complications in patients undergoing elective laparoscopic splenectomy. Background: The laparoscopic approach represents the "gold standard" for splenectomy, but its use in the treatment of splenomegaly and malignant disease is controversial. Factors that influence immediate outcome are clinical, anatomic, and pathologic. Methods: Univariate and multivariate analyses of data from the Italian Registry of Laparoscopic Surgery of the Spleen, a multicenter database supported by 25 referral centers. Analysis of data (1993-2007) was performed on a series of patients (n = 676) undergoing elective laparoscopic splenectomy. Demographic data, the operative indications, the surgical technique applied, and any intra-and/or postoperative complications with respect to the patients were assessed. Records were analyzed retrospectively using the Student t test, the χ test, and logistic regression. Results: Conversion to open splenectomy was necessary in 39 cases (5.8%). Perioperative deaths occurred in 3 cases (0.4%). There were no complications in 560 patients (82.8%), with a mean hospital stay of 5 days (range, 2-54). Overall, morbidity occurred in 116 patients (17.2%). Multivariate analysis found that the body mass index (P = 0.01) and the presence of hematologic malignancy (P <0.001) were independent predictors for intraoperative complications and surgical conversion. Spleen longitudinal diameter (P = 0.001) and surgical conversion (P = 0.001) were independent predictors for the occurrence of postoperative complications. Conclusions: This large multicenter study provides evidence for the significance of predictive risk factors for intra-and postoperative complications in laparoscopic splenic surgery. Besides splenic dimensions, other factors like the patient's habitus and the specific underlying hematologic pathology should be recognized by the surgeon to reduce complications and initiate adequate treatment.

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