Surgical Procedures: Splenectomy Due to Cancer

What is the spleen?

Your spleen is found under the upper left part of your abdomen (belly), under your rib cage. It is about the size of your fist. Your spleen filters blood, stores blood cells, and fights infections as part of your immune system. It helps find and destroy bacterial infections, removes damaged blood cells, and stores white blood cells called macrophages. The spleen helps blood flow to your liver.

What is a splenectomy and how is it done?

A splenectomy is the surgery done to remove your spleen. A splenectomy can help treat benign (noncancerous) and malignant (cancerous) conditions, such as some types of lymphomas and leukemias. After the spleen is removed, you are "asplenic.” Make sure to tell all of your healthcare providers that you no longer have a spleen.

There are two types of splenectomy:

• Partial Splenectomy: Part of the spleen is removed.
• Total Splenectomy: The whole spleen is removed. 

There are two ways to do a splenectomy:

• Open Surgery: An incision (surgical cut) is made through the center of your abdomen and the spleen is removed through the incision.
• Laparoscopic Surgery: Small incisions are made on your abdomen. Thin surgical tools and a camera are used to remove the spleen.

Your provider will talk with you about what kind of splenectomy you may need based on your overall health, diagnosis, age, and more.

What are the risks of a splenectomy?

As with any surgery, there are risks and side effects with a splenectomy. Risks and side effects may be:

• Infection.
• Bleeding.
• Pneumonia (infection in your lungs).
• Pancreatitis (swelling of your pancreas).
• Fluid leaking from your pancreas.
• Hernia where your laparoscopic incisions are.
• Injury to nearby organs such as the stomach, pancreas, and colon.
• Overwhelming Post-Splenectomy Infection (OPSI) is an infection that can happen after surgery.  It can be prevented with vaccinations before surgery. OPSI can also be treated with antibiotics if it does happen.
• Risk for future infections that may be life-threatening. You may need immunizations against pneumonia, influenza, Haemophilus influenza type b (Hib), and meningococci. Talk with your healthcare team about any vaccines you may need.

What is recovery like?

Your recovery from splenectomy depends on the type of surgery you had. If you had a laparoscopic splenectomy, you can often return home the same or following day. If you had an open surgery, you may need to stay in the hospital for up to 6 days. You will be taught how to care for your incision(s) before going home from the hospital.

Your medical team will talk with you about the medications you will be taking, such as those to prevent pain, blood clots, infection, and constipation, as well as medications for other conditions. 

Your healthcare provider will talk with you about changing your activity level. It can take several weeks to return to normal after a splenectomy.

Common instructions after a splenectomy include:

• No tub bathing for at least one week after surgery. You may be told that you can shower instead.
• Your provider will give you detailed information about when you can go back to strenuous physical activity.
• Not driving or using heavy machinery for 5 to 7 days after a splenectomy. Do not drive while taking pain medication.
• Changing your diet to increase your water and fiber intake. This will lessen your risk of constipation. Take medications as directed and only after speaking with your healthcare provider.

Call your care team if you have:

• Redness, warmth, or draining at your incision.
• Bleeding.
• Abdominal swelling.
• Signs of infection such as fever, chills or redness/tenderness at incision.
• Nausea or vomiting that does not go away, or being unable to eat or drink.
• A cough that doesn't go away and/or shortness of breath.
• Pain that is not helped 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 you can return to your normal activity level.

Take your medications as directed to prevent pain, infection and/or constipation and call your care team with any new symptoms.

Deep breathing and relaxation are important to help with pain, to keep lungs healthy after anesthesia, and to help with drainage of lymphatic fluid. Try to do 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, you are at a higher risk of infections for the rest of your life. You will need to be careful to avoid infections. You may be given immunizations before your splenectomy and you may need immunizations every year, 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 getting malaria.

Some people may have delayed healing from illness or injury after a splenectomy.

After a splenectomy, children under 5 and those with other health conditions may need antibiotics before certain procedures in the future.

Call your care team if you have any of the symptoms below after your spleen is removed:

• Fever. Your care team will tell you at what temperature you should call the office.
• Red or tender spots on your body, a sore throat, chills, or a cold that does not go away.
• Urinating (peeing) often or burning with urination.
• Other signs of infection.

Note: Patients who have had a splenectomy should tell their caregivers of their missing spleen and should think about wearing a medical alert bracelet. 

Note: Radiation therapy to the spleen makes the spleen non-functional (no longer works). 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.

Learn more about health concerns after splenectomy at OncoLink.

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