Surgical Procedures: Splenectomy Due to Cancer

What is the spleen?

The spleen is found under the upper left part of the belly and under the rib cage. The spleen is a fist sized, blood filled organ. It filters blood, stores blood cells, and fights infections. It is part of the immune system and is able to identify and destroy bacterial infections, remove damaged blood particles and store white blood cells called macrophages. The spleen also provides a continuous flow of blood to the liver.

What is a splenectomy and how is it performed?

A splenectomy is a surgical procedure in which all or part of the spleen is removed. A splenectomy can be done to treat both benign and cancerous conditions such as Hodgkin’s and non-Hodgkin’s lymphoma and some types of leukemia, such as chronic lymphocytic leukemia and hairy cell leukemia. After the spleen is removed, you are considered "asplenic.” It is important that anyone involved in your healthcare be aware of this fact.

There are two types of splenectomy:

• Partial Splenectomy: A partial splenectomy is removal of only a part of the spleen.
• Total Splenectomy: A total or complete splenectomy is removal of the whole spleen.

General anesthesia will be given for the procedure through an inhaled gas or in a liquid form through one of your veins. This is to help you sleep during the whole procedure and to manage pain.

There are two ways that a splenectomy can be performed:

• Open Surgery: An incision is made through the center of the belly and the spleen is removed through the incision.
• Laparoscopic Surgery: Small incisions are made on the belly to allow for the placement of laparoscopic surgical tools and the abdomen is filled/inflated with carbon dioxide. The laparoscopic camera is inserted and the surgeon is able to then remove the spleen with the other laparoscopic tools. Often, four small incisions are made for this procedure, however a larger incision is at times needed.

Note: Patients who undergo a laparoscopic splenectomy can often expect to have less postoperative pain, a shorter hospital stay, earlier return to a normal postoperative diet, an earlier return to normal pre-surgery activities with shorter recovery time, improved cosmetic results, and fewer incidence of incisional hernias.

What are the risks associated with a splenectomy?

As with any surgical procedure, there are risks and side effects associated with having a splenectomy. Risks and side effects may include:

• Infection.
• Bleeding.
• Post-operative pneumonia.
• Pancreatitis.
• Pancreatic fluid leakage.
• Hernia developing at the laparoscopic insertion site.
• Injury to surrounding organs such as the stomach, pancreas and/or colon.
• Overwhelming Post-Splenectomy Infection (OPSI) is a post-operative infection that is typically prevented by the use of pre-operative vaccinations and can be treated with antibiotics if it does develop.
• Risk for future infections which may be life-threatening. You may require immunizations against pneumonia, influenza, Haemophilus influenza type b (Hib) and meningococci. Speak with your healthcare providers for recommendations specifically for you.

What is recovery like?

Recovery from a splenectomy depends on the type of surgery you have had. For patients who had a laparoscopic splenectomy, often they return home the same or following day. For those who have had an open surgery, a two to six day hospital stay is typical. You will be taught how to care for your incision(s) before going home from the hospital.

Your medical team will discuss with you the medications you will be taking, such as those for prevention of pain, blood clots, infection, and constipation, along with medications that treat other conditions.

Your healthcare provider will discuss your particular activity restrictions depending on the surgery you have had. Often times, it takes several weeks to return to normal after a splenectomy.

Common activity restrictions and postoperative instructions for a splenectomy include:

• No tub bathing for at least one week following surgery. You may be told that you can shower instead.
• Speak with your healthcare provider about when you can resume strenuous physical activity.
• Driving should be avoided for 5 to 7 days following a splenectomy; do not drive while taking pain medication.
• Prevent constipation by increasing water and fiber intake. Take medications as directed and only after speaking with your healthcare provider.

Be sure to contact your healthcare team with any issues including:

• Incisional redness or drainage.
• Bleeding.
• Abdominal swelling.
• Signs of infection such as fever, chills or redness/tenderness at incision. 
• Persistent nausea, vomiting and/or inability to eat or drink.
• A cough that doesn't go away and/or shortness of breath.
• Pain that is unrelieved by medication.

How can I care for myself after surgery?

You may need a family member or friend to help you with your daily tasks until you are feeling better and your medical team gives you the go ahead to resume normal activity.

Be sure to take your medications as directed to prevent pain, infection and/or constipation and call your medical team with any concerning symptoms.

If you experience constipation, speak with your healthcare provider about taking over-the-counter medication to relieve constipation. Diet modifications and increasing fluid intake may be beneficial. If you are experiencing constipation unrelieved by the measures you have been instructed on, contact your healthcare team for instruction.

Deep breathing and relaxation are important to help with pain, keep lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to perform deep breathing and relaxation exercises several times a day in the first week, or whenever you notice you are particularly tense.

• A simple exercise to do on your own: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

Health Concerns After Splenectomy

After a splenectomy, patients are at a higher risk for getting infections for the rest of their lives. You will need to be careful to avoid infections. Many patients will have been given immunizations pre-operatively. However, you may require annual immunizations, like the flu vaccine, and a pneumonia vaccine every 5 years. It is important to avoid traveling to locations where there is a risk of contracting malaria.

Some people may experience delayed healing from illness or injury.

Preventative antibiotics may be recommended, most commonly in children under 5 or with other health conditions which would affect their risk for contracting an infection. This preventative antibiotic therapy may be necessary for several years. Learn more about heath concerns after splenectomy on OncoLink.

It is important to speak with your healthcare provider if you have any of the symptoms below after your spleen is removed:

• Fever. Ask your provider at what temperature they want to be notified.
• The presence of red or tender spots on the body, a sore throat, chills or a persistent cold.
• Urinary frequency or burning with urination. 
• Any other sign of a possible infection.

Note: Patients who have undergone splenectomy should inform their caregivers of their missing spleen and possibly wear a medical alert bracelet.

Note: Radiation to the spleen makes the spleen non-functional. After radiation to the spleen, you are considered to not have a functioning spleen (asplenic) and need to follow similar precautions to someone who has had their spleen removed.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.