The Prognostic Impact of Splenectomy in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

In this study, we aimed to investigate the prognostic impact of splenectomy on post-operative complications and the long-term oncologic results of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for treating peritoneal metastasis. All consecutive patients who underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal metastasis were analysed between 2007 and 2020. In addition to clinicopathological features, peritoneal cancer index, completeness of cytoreduction, (neo-)adjuvant chemotherapy, operative time, need for surgical intensive care unit, use of albumin, erythrocyte suspension and fresh frozen plasma, infectious and non-infectious post-operative complications were evaluated. The data of 660 patients were analysed, and splenectomy was performed in 92 patients (13.9%). The 3- and 5-year-survival rates were significantly lower in the splenectomy group (42.9% and 25.6% vs. 50.2% and 34.0%; p =.038). High peritoneal cancer index score (OR, 2.34; 95%CI, 1.40–3.90; p = .001) and the number of resected organs (OR, 4.34; 95%CI, 2.58–7.29; p = .000) were significant risk factors in the splenectomy group. Age (HR, 1.01; 95%CI, 1.01–1.03; p = .002), high peritoneal cancer index score (HR, 1.59; 95%CI, 1.18–2.15; p = .002), smoking (HR, 1.39; 95%CI, 1.04–1.87; p = .028), intraoperative erythrocyte suspension (HR, 2.37; 95%CI, 1.69–3.31; p <.001), intraoperative fresh frozen plasma (HR, 0.66; 95%CI, 0.46–0.93; p = .019) usage and infection (HR, 1.51; 95%CI 1.11–2.06; p = .009) were independent, robust prognostic factors in Cox regression analysis. Splenectomy was associated with increased morbi-mortality and post-operative infections and decreased overall survival in patients with peritoneal metastasis who underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.