Splenectomy as an indicator for ovarian cancer spread and complete cytoreduction

Objective

Complete cytoreductive surgery (CRS) is a gold standard in advanced ovarian cancer (OC) treatment, and most of the time, requires upper abdominal procedures. However, there is an enormous variation regarding the reported incidence of splenectomies, and the safety and prognosis of this procedure is largely unknown. The aim of this study was to evaluate the impact of splenectomy on surgical outcomes, complications and overall survival (OS) in primary OC surgery.

Methods

This prospective observational cohort study comprised patients with stage IIIC-IV OC who underwent primary CRS. Cases and controls were defined based on whether splenectomy had been performed or not. Comparisons between the groups were made using logistic regression models, receiver-operator characteristics and survival analyses i.e. Kaplan-Meier and Cox proportional hazard models.

Results

Splenectomy was performed in 206/354 (58 %) patients, and among these - 170 (82.5 %) spleen metastases were identified. High peritoneal cancer index (PCI) was an independent predictor of splenectomy (aOR = 1.27 [95 % CI: 1.21–1.34]), with a PCI cut-off of 16 indicating need for splenectomy (AUC = 0.884). Splenectomy, PCI and surgical complexity score were all independent predictors of high-grade postoperative complications. Splenectomy, high PCI and completeness of cytoreduction were independent predictors of worse OS. Type of spleen metastasis (hilar/capsular versus parenchymal) did not influence OS.

Conclusions

Splenic metastatic involvement is common in OC and splenectomy is predicted by high PCI. Survival prognosis is equally impaired by all types of spleen metastasis. Splenectomy is an indicator of high tumour burden, high surgical complexity and high-grade postoperative complications, impaired survival and, indirectly, of cytoreduction success.