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 chi 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.

Putative predictive parameters for the outcome of laparoscopic splenectomy: a multicenter analysis performed on the Italian Registry of Laparoscopic Surgery of the Spleen / Casaccia, M; Torelli, P; Pasa, A; Sormani, Mp; Rossi, E; Valente, U; Spinoglio, G; Prete, F; Logrieco, G; Buccoliero, F; Berta, R; Donini, I; Donini, A; Valeri, A; Prosperi, P; Saviano, Massimo; Gelmini, Roberta; Uggeri, F; Caprotti, R; Romano, F; Colecchia, G; Monteferrante, E; Pedrazzoli, C; Bigi, L; Barbieri, Im; Moraldi, A; Dallatorre, A; Basso, N; Silecchia, G; Rosati, R; Bona, S; Cavaliere, P; Bresadola, F; Terrosu, G; Mosca, F; Pietrabissa, A; Memeo, V; Puglisi, F; Dionigi, R; Benevento, A; Boni, L; Liboni, A; Feo, C; Borghi, F; Geretto, P; Torelli, P; Moroni, R; Sorrentino, M; di Sebastiano, P; Ambrosio, A; Verdecchia, Gm; Cavaliere D., IRLSS Centers. - In: ANNALS OF SURGERY. - ISSN 0003-4932. - STAMPA. - 251(2):(2010), pp. 287-291. [10.1097/SLA.0b013e3181bfda59]

Putative predictive parameters for the outcome of laparoscopic splenectomy: a multicenter analysis performed on the Italian Registry of Laparoscopic Surgery of the Spleen

SAVIANO, Massimo;GELMINI, Roberta;
2010

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 chi 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.
2010
251(2)
287
291
Putative predictive parameters for the outcome of laparoscopic splenectomy: a multicenter analysis performed on the Italian Registry of Laparoscopic Surgery of the Spleen / Casaccia, M; Torelli, P; Pasa, A; Sormani, Mp; Rossi, E; Valente, U; Spinoglio, G; Prete, F; Logrieco, G; Buccoliero, F; Berta, R; Donini, I; Donini, A; Valeri, A; Prosperi, P; Saviano, Massimo; Gelmini, Roberta; Uggeri, F; Caprotti, R; Romano, F; Colecchia, G; Monteferrante, E; Pedrazzoli, C; Bigi, L; Barbieri, Im; Moraldi, A; Dallatorre, A; Basso, N; Silecchia, G; Rosati, R; Bona, S; Cavaliere, P; Bresadola, F; Terrosu, G; Mosca, F; Pietrabissa, A; Memeo, V; Puglisi, F; Dionigi, R; Benevento, A; Boni, L; Liboni, A; Feo, C; Borghi, F; Geretto, P; Torelli, P; Moroni, R; Sorrentino, M; di Sebastiano, P; Ambrosio, A; Verdecchia, Gm; Cavaliere D., IRLSS Centers. - In: ANNALS OF SURGERY. - ISSN 0003-4932. - STAMPA. - 251(2):(2010), pp. 287-291. [10.1097/SLA.0b013e3181bfda59]
Casaccia, M; Torelli, P; Pasa, A; Sormani, Mp; Rossi, E; Valente, U; Spinoglio, G; Prete, F; Logrieco, G; Buccoliero, F; Berta, R; Donini, I; Donini, A; Valeri, A; Prosperi, P; Saviano, Massimo; Gelmini, Roberta; Uggeri, F; Caprotti, R; Romano, F; Colecchia, G; Monteferrante, E; Pedrazzoli, C; Bigi, L; Barbieri, Im; Moraldi, A; Dallatorre, A; Basso, N; Silecchia, G; Rosati, R; Bona, S; Cavaliere, P; Bresadola, F; Terrosu, G; Mosca, F; Pietrabissa, A; Memeo, V; Puglisi, F; Dionigi, R; Benevento, A; Boni, L; Liboni, A; Feo, C; Borghi, F; Geretto, P; Torelli, P; Moroni, R; Sorrentino, M; di Sebastiano, P; Ambrosio, A; Verdecchia, Gm; Cavaliere D., IRLSS Centers
File in questo prodotto:
File Dimensione Formato  
Milza AnnSurg2010Registro.pdf

Solo gestori archivio

Tipologia: Versione pubblicata dall'editore
Dimensione 204.33 kB
Formato Adobe PDF
204.33 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/712601
Citazioni
  • ???jsp.display-item.citation.pmc??? 7
  • Scopus 50
  • ???jsp.display-item.citation.isi??? 42
social impact