Splenic Hydatid Cysts Treated by Partial Splenectomy: Case Series and Literature Review.

PURPOSE: Hydatic cysts (HC) rarely occur primarily in the spleen. Partial splenectomy (PS) is an established procedure for preserving spleen parenchyma, but rarely used in the treatment of HC. We aim to present our experience with PS for HC and to review the literature of splenic HC treated by PS. Material and Methods: The databases of PS performed between 2000 and 2023 in the Department of General Surgery of Fundeni Clinical Institute (Bucharest) for HC have been reviewed retrospectively. Searching the PubMed, Medline, and Google Scholar databases for keywords such as "partial splenectomy", "splenic hydatid cyst" etc, we retrieved publications from 2000 to December 2023 in English for a literature review. We excluded studies which were not published in English and studies which did not provide accurate or specific data regarding the treatment of splenic HC by PS. Results: There were 10 PS for HC. Six females and 4 males, ages between 16 and 41 (31Ã+-8.43), 9 with HC in the upper splenic pole (UP) treated by PS with lower pole (LP) preservation and one inferior pole HC treated by LP PS. There were 4 open, 2 laparoscopic and 4 robotic PS. There were no complications or recurrences at follow up (2 years). The literature review consists of 14 full-text articles, presenting 42 PS for HC. CONCLUSION: PS for HC is feasible, achieves complete removal of the cyst, while preserving splenic function. The procedure can be performed laparoscopically or robotically with the advantages of minimally invasive surgery.

The Decline of Open, Laparoscopic, and Robotic Splenectomies: A Single Center Experience.

Background: Splenectomy has been performed for various indications from haematological diseases to benign cysts and tumours, and for splenic traumatic injuries. However, there has been a steady decline in splenectomies in the last 20 years. The aim of this study is to establish the reasons behind this decline in splenectomy and to analyse them based on indication, type of splenectomy, and manner of approach (open, laparoscopic or robotic). Material and Methods: This is a retrospective study of a single centre experience of all the splenectomies, both total and partial, performed in the Department of General Surgery of Fundeni Clinical Institute (Bucharest) between 2002 and 2023. Only surgeries for primary splenic diseases were selected, splenic resections as part of other major operations were not included. Results: Between 2002 and 2023, 876 splenectomies were performed in the Department of General Surgery of Fundeni Clinical Institute (Bucharest). Most splenectomies (n=245) were performed for immune thrombocytopenic purpura (ITP), followed by benign tumours and cysts (n=136), lymphoma (n=119), hypersplenism due to cirrhosis (n=107) and microspherocytosis (n=95). Other indications included myelodysplastic syndrome (n=39), trauma (n=35), thalassemia (n=22), leukaemia (n=18) and also there were 60 splenectomies that were performed for hypersplenism of unknown cause. There were 795 total splenectomies (TS) and 81 partial splenectomies (PS). There was a decline in the number of splenectomies both TS and PS for all these indications, most notably in the case of ITP, microspherocytosis and hypersplenism due to cirrhosis with no splenectomies performed for these indications since 2020. Conclusion: With the development of new lines of treatment, advances in interventional radiology and in surgery with the spleen parenchyma sparing options, the need for total splenectomy has been greatly reduced which is reflected in the decline in the number of splenectomies performed in the last 20 years in our clinic.

Pelvic Exenteration - Past, Present and Future.

Background: Bearing in mind that the open procedure is already validated by multiple studies, the article aims to prove that pelvic exenteration performed in a minimally invasive fashion might offer better survival and to potentially identify prognostic factors for the outcome of these patients. Material and Methods: Data regarding past and present classifications and surgical indications are presented. Patient data were collected retrospectively. Results: The most frequent diseases treated with pelvic exenteration, in terms of the hystological type, were gynecological malignancy and squamous cell carcinoma. Recurrent pelvic disease was found in 68.2% of patients. R0 resection was achieved in 72.7% of patients in the MI group, and in 73.7% of patients in the OP group. Peri-operative morbidity was reported to be 56.6% for open surgery, and 18.1% for minimally invasive. Average DFS was 20.15 months, ranging from 1.5 to 70.3 months, while the OS was calculated to be 38.1 months (0.33 1508) up until November 2023. Conclusion: Pelvic exenteration is a continuously improving surgical procedure, open approach being favored to minimally invasive one. On the other hand, hospitalization and morbidity are reduced when choosing the latter. R0 and lymph node status are important predictors for overall survival, as well as major early postoperative complications. All in all, pelvic exenteration is still a promising surgical procedure to extend cancer patients lives.