Spleen removal surgery safe, effective for myelofibrosis patients

Splenectomy, the surgical removal of the spleen, remains a safe and effective treatment option for certain people with myelofibrosis and other blood-related diseases, according to a 27-year case review from a single Australian teaching hospital.

Since 2017, all patients who underwent this procedure have undergone laparoscopic surgery, performed through small incisions with a camera, which has had fewer complications than previously used open surgery that uses a single, large incision.

“Although the development of new medical and interventional therapies has meant fewer patients require splenectomy, it remains a valid option for some indications and in selected patients,” the researchers wrote.

The study, “Long-Term Outcomes After Elective Splenectomy for Haematological Disease: A 27-Year Single-Centre Study,” was published in the ANZ Journal of Surgery.

Myelofibrosis is caused when abnormal blood cells lead to inflammation and scarring (fibrosis) in the bone marrow, interfering with healthy blood cell production and resulting in blood cell deficiencies and related myelofibrosis symptoms. The spleen, trying to compensate by producing blood cells, becomes enlarged, a condition known as splenomegaly.

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A splenectomy to remove the spleen can be used to treat splenomegaly in people with myelofibrosis. Because of the risks of surgery, however, it’s typically reserved for patients who don’t adequately respond to standard myelofibrosis therapies.

The procedure is also used for other blood-related diseases, including lymphoma, a type of blood cancer; immune thrombocytopaenia (ITP), an immune attack on blood-clotting platelets; and autoimmune hemolytic anemia (AIHA), an immune attack on red blood cells.

Because advances in targeted medicines and minimally invasive surgery have changed the role of splenectomies, a team in Australia examined the evolving indications and outcomes of elective splenectomy at a teaching hospital over 27 years.

Seventy patients, ages 18-85, underwent elective splenectomy between 1999 and 2025; about half (54.3%) were women. The team noted a significant decrease in the annual splenectomy caseload over the study period.

Roughly half of the patients (45.7%) had malignant blood cancers, namely myelofibrosis and lymphoma, while the rest (54.3%) had non-malignant indications, ITP and AIHA.

Most patients (74%) underwent laparoscopic surgery. Still, its use rose from 65.1% in 1999 to 2007 to 85% in 2008 to 2016, and then to all cases (100%) from 2017 to 2025. Conversely, the transition from laparoscopic to open surgery decreased over time: 25.0% to 5.8% to 0%.

Similarly, the mean operative time dropped significantly from 134.6 minutes to 100.3 minutes to 91.0 minutes after 2017. The median length of hospital stay was five days. Accessory spleens, small extra pieces of spleen tissue, were found and removed in eight patients (11.4%).

After surgery, one in five (21.4%) patients developed complications, most of them minor. Even so, complications occurred more than twice as often after open surgery as after laparoscopic surgery (38.8% vs. 15.3%). Four patients (5.7%) had major complications requiring invasive, life-supporting, or intensive care. No deaths were reported within 90 days of surgery.

Massive splenomegaly, a markedly enlarged spleen, was treated far more often by open surgery than in those without such involvement (86% vs. 10%). The condition was more common in older patients (median age 65.5 vs. 56.5) and in those with a malignant diagnosis (93% vs. 40%). These patients also had longer hospital stays (median six vs. five days).

Participants with massive splenomegaly were twice as likely to have post-operative complications (33% vs. 15%). All had undergone open surgery, likely “reflecting surgical judgment of the technical challenges and intra-operative risks associated with larger spleens,” the team wrote.

All received vaccination against pneumococcus, meningococcus, and Haemophilus influenzae type B at least two weeks before surgery. No patient died of post-splenectomy infection, a rare, severe infection that can follow spleen removal.

One person succumbed to pneumococcal sepsis three years after splenectomy, after a stem cell transplant for recurrent non-Hodgkin lymphoma. One patient developed splenic vein thrombosis, a blood clot in the splenic vein, requiring blood thinners.

Over a median follow-up of 9.1 years, 41 patients (59%) were alive. Of the 27 who died, the cause of death for half (51.9%) was recurrent or persistent blood-related malignancy, while about one in three (37.0%) died from causes unrelated to the spleen.

The team concluded that despite declining referrals in the era of targeted therapies, “splenectomy remains a safe and effective treatment option in selected patients,” adding that surgeons should be aware of splenectomy’s potential benefits for hematological disease.