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Tivadar BM, Dumitrascu T, Vasilescu C. A Glimpse into the Role and Effectiveness of Splenectomy for Isolated Metachronous Spleen Metastasis of Colorectal Cancer Origin: Long-Term Survivals Can Be Achieved. J Clin Med 2024; 13:2362. [PMID: 38673636 PMCID: PMC11050850 DOI: 10.3390/jcm13082362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Many papers exploring the role of resectioning metastases in colorectal cancer (CRC) have focused mainly on liver and lung sites, showing improved survival compared with non-resectional therapies. However, data about exceptional metastatic sites such as splenic metastases (SMs) are scarce. This paper aims to assess the role and effectiveness of splenectomy in the case of isolated metachronous SM of CRC origin. Methods: The patients' data were extracted after a comprehensive literature search through public databases for articles reporting patients with splenectomies for isolated metachronous SM of CRC origin. Potential predictors of survival were explored, along with demographic, diagnostic, pathology, and treatment data for each patient. Results: A total of 83 patients with splenectomies for isolated metachronous SM of CRC origin were identified. The primary CRC was at an advanced stage (Duke's C-70.3%) and on the left colon (45.5%) for most patients, while the median interval between CRC resection and SM was 24 months. The median overall survival after splenectomy was 84 months, and patients younger than 62 years presented statistically significantly worse overall survival rates than those ≥62 years old (p = 0.011). There was no significant impact on the long-term outcomes for factors including primary tumor location or adjuvant chemotherapy (p values ≥ 0.070, ns). Laparoscopic splenectomy was increasingly used in the last 20 years from 2002 (33.3% vs. 0%, p < 0.001). Conclusions: Splenectomy is the optimal treatment for patients with isolated metachronous SM of CRC, with the laparoscopic approach being increasingly used and having the potential to become a standard of care. Encouraging long-term survival rates were reported in the context of a multidisciplinary approach. Younger ages are associated with worse survival. Perioperative chemotherapy in the context of a patient diagnosed with SM of CRC origin appears to be a reasonable option, although the present study failed to show any significant impact on long-term survival.
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Affiliation(s)
| | - Traian Dumitrascu
- Department of General Surgery, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Fundeni Street No. 258, 022328 Bucharest, Romania; (B.M.T.); (C.V.)
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Chaudhary P, Bhadana U, Chandran S, Agarwal A, Kapur N. A Retrospective Cohort Study of Gastrosplenic Fistula Secondary to Malignant Etiology: Single-Centre Experience of 5 Cases. Indian J Surg Oncol 2023; 14:42-47. [PMID: 36891431 PMCID: PMC9986358 DOI: 10.1007/s13193-022-01615-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022] Open
Abstract
Gastrosplenic fistula is an uncommon manifestation of malignancy of the stomach and spleen. The aim of this study is to present our 10-year experience on gastrosplenic fistula secondary to malignant etiology. Endoscopy, imaging, and histopathology records of all the patients with gastric and splenic malignant pathologies were reviewed retrospectively. The protocol was approved by the ethical review board of the institute. Descriptive statistics were used to summarize the data. A total of 5 cases were found to have gastrosplenic fistula. Of these 5 cases, 2 were due to large B cell lymphoma of the spleen, 1 was secondary to Hodgkin's lymphoma of the stomach, 1 case was due to diffuse large B cell non-Hodgkin's lymphoma of the stomach, and 1 patient was secondary to gastric adenocarcinoma. Gastrosplenic fistula is an exceptionally rare complication of gastrointestinal malignancy. Lymphoma of the spleen is the commonest cause while gastric adenocarcinoma causing gastrosplenic fistula is extremely rare. Most cases occur spontaneously.
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Affiliation(s)
- Poras Chaudhary
- Department of General Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Utsav Bhadana
- Department of General Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Subhash Chandran
- Department of General Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Achint Agarwal
- Department of General Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Neeti Kapur
- Department of General Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
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Borgharia S, Juneja P, Hazrah P, Lal R, Kapur N, Chaudhary P. Gastrosplenic Fistula: a Systematic Review. Indian J Surg Oncol 2022; 13:652-660. [PMID: 36187537 PMCID: PMC9515263 DOI: 10.1007/s13193-022-01551-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/19/2022] [Indexed: 11/09/2022] Open
Abstract
Gastrosplenic fistula is an unusual complication of benign as well as malignant gastric and splenic pathologies. This pathology acquires an important clinical significance due to its rare association with life-threatening upper gastrointestinal haemorrhage. The aim of this article is to review the English-language literature in order to gain a better understanding of etiological factors, diagnostic evaluation, and management of gastrosplenic fistula. The systematic search of the literature was performed on PubMed and MEDLINE from January 1950 to September 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. We retrieved 44 articles matching our selection criteria from the search. There were 3 case series, 37 case reports, and 4 review of the literature. In our appraisal of articles published in PUBMED, a total of 36 cases of malignant and 10 cases of benign gastrosplenic fistula could be identified. Gastrosplenic fistula is an exceptional complication of malignancies of the gastrointestinal tract. Lymphomas particularly arising from the spleen are the commonest cause. Gastric adenocarcinoma causing GSF is extremely rare. Most cases occur spontaneously, but at times, it can be secondary to tumour necrosis following chemotherapy.
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Affiliation(s)
- Saurabh Borgharia
- Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Preeti Juneja
- Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Priya Hazrah
- Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Romesh Lal
- Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Neeti Kapur
- Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Poras Chaudhary
- Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
- Atal Bihari Vajpayee Institute of Medical Sciences &, Dr Ram Manohar Lohia Hospital, New Delhi, India
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Ashkenazi I, Olsha O, Kessel B, Krausz MM, Alfici R. Uncommon acquired fistulae involving the digestive system: summary of data. Eur J Trauma Emerg Surg 2011; 37:259-67. [PMID: 26815108 DOI: 10.1007/s00068-011-0112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 04/16/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Most gastrointestinal fistulae commonly occur following surgery. A minority is caused by a myriad of other etiologies and is termed by some as "uncommon fistulae". The aim of this study was to review these fistulae and their treatment. METHODS A literature review was carried out. Searches were conducted in Pubmed and related references reviewed. RESULTS Except for Crohn's disease and diverticulitis, "uncommon fistulae" are described in case reports or very small case series. Most of the patients were treated by surgery. CONCLUSIONS The anatomic features of the fistula and the etiology usually dictate the approach. Most patients will eventually need surgery to resolve this pathology.
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Affiliation(s)
- I Ashkenazi
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel.
| | - O Olsha
- Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - B Kessel
- Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - M M Krausz
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel
| | - R Alfici
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel
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Seib CD, Rocha FG, Hwang DG, Shoji BT. Gastrosplenic Fistula From Hodgkin's Lymphoma. J Clin Oncol 2009; 27:e15-7. [DOI: 10.1200/jco.2008.21.7695] [Citation(s) in RCA: 542] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Carolyn D. Seib
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Flavio G. Rocha
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Dick G. Hwang
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Brent T. Shoji
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Pisanu A, Ravarino A, Nieddu R, Uccheddu A. Synchronous isolated splenic metastasis from colon carcinoma and concomitant splenic abscess: A case report and review of the literature. World J Gastroenterol 2007; 13:5516-20. [PMID: 17907299 PMCID: PMC4171290 DOI: 10.3748/wjg.v13.i41.5516] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This study aimed to describe a case in which an isolated splenic metastasis was synchronous with the colonic primary and a concomitant splenic abscess was associated. A wide review of the literature was also performed. A 54-year-old woman with abdominal pain and fever was admitted to our department. Abdominal CT revealed two low-density areas in the spleen and wall-thickening of the left colonic flexure, which was indistinguishable from the spleen parenchyma. The patient underwent emergency celiotomy, with the presumptive diagnosis of obstructing colon carcinoma of the splenic flexure, and concomitant splenic abscess. Subtotal colectomy and splenectomy were performed. Pathological findings were consistent with mucinous colonic carcinoma, synchronous isolated splenic metastasis and concomitant splenic abscess. This paper is also a review of the existing literature on the association between colorectal cancer and splenic metastasis. Only 41 cases of isolated splenic metastasis from colon carcinoma have been reported in the literature. This report is the third described case of synchronous isolated splenic metastasis from colon carcinoma. Only one case with concomitant splenic abscess has been previously reported. When obstructing left-sided colorectal cancer is suspected, careful CT examination can allow early diagnosis of splenic involvement by the tumor. The literature review suggests that there might be a significant improvement in survival following splenectomy for a metachronous isolated splenic metastasis from colon carcinoma. Prognosis for synchronous splenic metastasis seems to be related to the advanced stage of the disease. Nevertheless, no definitive conclusions can be drawn because of the small number of cases.
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Affiliation(s)
- Adolfo Pisanu
- Clinica Chirurgica, Università degli Studi di Cagliari, Ospedale San Giovanni di Dio, Via Ospedale 46, Cagliari 09124, Italy.
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Kerem M, Sakrak O, Yilmaz TU, Gultekin FA, Dursun A, Bedirli A. Spontaneous gastrosplenic fistula in primary gastric lymphoma: Surgical management. Asian J Surg 2006; 29:287-90. [PMID: 17098664 DOI: 10.1016/s1015-9584(09)60104-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Gastrosplenic fistula formation resulting from primary gastric malignancy is rare and should be managed as a matter of emergency. We report a patient who was diagnosed with primary non-Hodgkin's lymphoma and who underwent surgical treatment for gastrosplenic fistula.
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Affiliation(s)
- Mustafa Kerem
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.
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