Minimally Invasive Splenectomy for Recurrent Gynecologic Cancer and Long-Term Outcomes.

STUDY

Objective

To evaluate the surgical safety, feasibility, and long-term oncologic outcomes of minimally invasive (MIS) splenectomy in patients with isolated or oligometastatic recurrence of gynecologic malignancies.

Design

Retrospective single-institution cohort study (AAGL Classification of Evidence: II-3).

Setting

Tertiary academic referral center (Mayo Clinic, Arizona, USA). PATIENTS Ten consecutive women with platinum-sensitive recurrent gynecologic cancer (6 ovarian, 2 endometrial, 2 cervical) involving the spleen or left upper quadrant. Eight patients had pathologically confirmed recurrent gynecologic malignancy; in 2, pathology revealed non-gynecologic disease (necrotizing granuloma; B-cell lymphoma). The primary oncologic analysis was restricted to the 8 confirmed cases.

Interventions

MIS splenectomy (laparoscopic, n=6; robotic, n=4) for secondary or tertiary cytoreduction, with concomitant procedures when needed for complete resection.

Measurements

AND MAIN

Results

All procedures were completed minimally invasively without conversion. Median operative time was 202 minutes (IQR 196.5-211.5; range 108-325) and median estimated blood loss was 50 mL (IQR 50-125; range 20-450). No intraoperative complications occurred. Postoperative complications were limited to Clavien-Dindo grade I-II; median Comprehensive Complication Index was 11.2. Median hospital stay was 42 hours (IQR 25.5-72.25). R0 resection was achieved in 10/10 patients (100%). In the primary analysis (n=8), at a median follow-up of 53.8 months after splenectomy, one patient developed recurrence at 78.5 months and no patient had died; five-year overall survival and five-year disease-free survival were both 100% (exact 95% CI 39.8-100%). Survival estimates should be interpreted cautiously given the small sample size.

Conclusion

In this highly selected cohort treated at a tertiary referral center, MIS splenectomy appeared technically feasible and short-term safe and was associated with favorable observed oncologic outcomes. These findings support feasibility but do not establish causal oncologic efficacy.