Patients operated on for esophageal cancer by surgeons who often perform such operations run a lower risk of splenic injury during the operation and of needing to have their spleen removed, an intervention which increases the risk of serious infection and death. This is shown by an extensive new study from Karolinska Institutet which has been published in the scientific journal Annals of Surgery. These results lend additional support to the view that surgery for esophageal cancer ought to be performed by a smaller number of surgeons, who will gain the opportunity to carry out more operations, the researchers believe.
Esophageal cancer is an aggressive illness with a gloomy prognosis. As only one patient in four is suitable for surgical treatment the operation is relatively infrequent in Sweden. At the same time the intervention is one of the most extensive, with surgery in the abdomen, chest and sometimes also the neck, and there is a high risk of complications. During the operation most of the esophagus is removed and the part that is taken is normally replaced with the stomach which is detached from its anchorages in the abdomen and reshaped into a narrow tube. A complication that is feared in connection with the detaching of the stomach is damage to the spleen, which sometimes leads to the organ having to be removed. A few limited studies have indicated an increased risk of death after removal of the spleen during surgery for esophageal cancer. The aim of the current study was to identify factors that increase the risk of damage to the spleen and of its removal and also to clarify the connection between removal of the spleen and risk of death and serious infections
The research group examined data on virtually all patients operated on for esophageal cancer in Sweden between 1987-2010. The analyses took into account several factors that could have influenced the results. It was found that neither the sex of the patient, nor the age, nor the severity of the tumour affected the risk of damage to the spleen or of having to remove it. On the other hand the risk of damage to the spleen was 42 per cent lower if the surgeon performed this type of operation frequently. The risk of the spleen having to be removed in connection with the operation was 59 per cent lower. The results indicate that this surgery ought to be concentrated on a smaller number of surgeons.
The study also showed that the risk of death and serious infections, for example blood poisoning, increased when the spleen was removed in the course of the operation. This indicates that the surgeon should if possible repair a damaged spleen.
Splenic Injury During Resection for Esophageal Cancer : Risk Factors and Consequences, Maryam Derogar, Omid Sadr-Azodi, Pernilla Lagergren, Jesper Lagergren, Annals of Surgery, DOI: 10.1097/SLA.0000000000000650, published 2 May 2014.