Valoración geriátrica integral: influencia en los resultados clínicos de la cirugía colorrectal en pacientes de edad muy avanzada / Comprehensive geriatric assessment: Influence on clinical results after colorectal surgery in advanced age patients

Introducción: El objetivo de este trabajo fue analizar los resultados clínicos postoperatorios de los pacientes tratados quirúrgicamente por cáncer colorrectal en relación con los resultados de la valoración geriátrica integral preoperatoria. Métodos: Estudio observacional en el que se analizó la morbimortalidad postoperatoria a los 30 y 90 días en una cohorte de pacientes intervenidos por cáncer colorrectal según grupos de edad: grupo 1) edad entre 75 y 79 años; grupo 2) entre los 80 y los 84 años, y grupo 3) ≥85 años. Además de la evaluación del riesgo anestésico, se evaluó a los pacientes con los índices de Karnofsky, Barthel y Pfeiffer. Se analizó la mortalidad a los 30 y 90 días de la cirugía en relación con los resultados de la evaluación integral. Resultados: Se incluyeron 227 pacientes afectados de cáncer colorrectal en el periodo de estudio: 91 del grupo 1, 89 del grupo 2 y 47 del grupo 3. Hubo diferencias estadísticamente significativas en la mortalidad a los 30 días (p=0,029), pero no a los 90 días de la cirugía, según los grupos de edad. La mortalidad a los 90 días fue significativamente superior en los pacientes con peores puntuaciones en las escalas de Karnofsky y Barthel. Conclusiones: La valoración geriátrica integral mediante distintas escalas es una buena herramienta para evaluar la mortalidad postoperatoria en el postoperatorio a medio plazo.(AU)

Introduction: The objective of this work was to analyse the postoperative clinical results of patients surgically treated for colorectal cancer in relation to the results of the preoperative comprehensive geriatric evaluation. Methods: Observational study in which postoperative morbidity and mortality at 30 and 90 days were analysed in a cohort of patients surgically treated for colorectal cancer according to age groups: group 1) between 75 and 79 years old; group 2) between 80 and 84 years old, and group 3) ≥85 years old. In addition to the anaesthetic risk assessment, patients were assessed with the Karnofsky, Barthel and Pfeiffer indexes. Mortality at 30 and 90 days after surgery was analysed in relation to the results of the comprehensive evaluation. Results: A total of 227 patients with colorectal cancer were included in the study period: 91 in group 1, 89 in group 2 and 47 in group 3. There were statistically significant differences in mortality at 30 days (p=0,029) but not at 90 days after surgery, according to age groups. Mortality at 90 days was significantly higher in patients with worse scores on the Karnofsky and Barthel scales. Conclusions: Comprehensive geriatric assessment using different scales is a good tool to assess postoperative mortality in the mid-term postoperative period.(AU)

Preoperative Assessment of Geriatric Surgical Patients: Update on Clinical Scales Used for Elective General and Digestive Surgery.

BACKGROUND: Higher life expectancy in the general population entails a growing interest in the surgical management of diseases affecting elderly patients. Preoperative assessment when planning surgery needs to carefully evaluate physical and functional status of the patient. This review aims to describe the most commonly used scales in the evaluation of elderly patients scheduled for surgery and provides a useful tool to decide the scales that would be better to assess these specific patients. METHODS: According to the PRISMA statement of publications published, we have carried out a systematic review focused on elderly patients who underwent surgical procedures in General and Surgery. Using Medline, Embase, and Cochrane library, a systematic search of the literature from 1992 to 2018 was performed. This enabled us to retrieve information from the selected articles on scales to evaluate medical fitness, functional status, or both, in the elderly or frail patients. RESULTS: We reviewed 102 articles and selected the most frequently used assessment scales or indexes. After this extensive analysis, we selected 4 functional scales (Katz Index, Barthel Scale, Karnofsky Performance Score, and Vulnerable Elders Survey), 4 clinical scales (American Society of Anaesthesiologists Index, Charlson Comorbidity Index, Pfeiffer Test, and Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity Scale) and finally, 2 mixed scales (American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator and Edmonton Frail Scale). CONCLUSIONS: No consensus on the use of a unified assessment scale for elderly patients exists. However, with this review, we provide a brief guideline about the most useful and used scales to perform a comprehensive assessment of geriatric patients undergoing surgery.

Comprehensive geriatric assessment: Influence on clinical results after colorectal surgery in advanced age patients. / Valoración geriátrica integral: influencia en los resultados clínicos de la cirugía colorrectal en pacientes de edad muy avanzada.

INTRODUCTION: The objective of this work was to analyse the postoperative clinical results of patients surgically treated for colorectal cancer in relation to the results of the preoperative comprehensive geriatric evaluation. METHODS: Observational study in which postoperative morbidity and mortality at 30 and 90 days were analysed in a cohort of patients surgically treated for colorectal cancer according to age groups: group 1) between 75 and 79 years old; group 2) between 80 and 84 years old, and group 3) ≥85 years old. In addition to the anaesthetic risk assessment, patients were assessed with the Karnofsky, Barthel and Pfeiffer indexes. Mortality at 30 and 90 days after surgery was analysed in relation to the results of the comprehensive evaluation. RESULTS: A total of 227 patients with colorectal cancer were included in the study period: 91 in group 1, 89 in group 2 and 47 in group 3. There were statistically significant differences in mortality at 30 days (p=0,029) but not at 90 days after surgery, according to age groups. Mortality at 90 days was significantly higher in patients with worse scores on the Karnofsky and Barthel scales. CONCLUSIONS: Comprehensive geriatric assessment using different scales is a good tool to assess postoperative mortality in the mid-term postoperative period.

Survival and quality of life after surgery for colorectal cancer in the elderly: a comparative study

Background: the aim of this study was to analyze the clinical results of the multidisciplinary management of elderly patients with colorectal cancer in a single center and to describe postoperative quality of life. Methods: a comparative study was designed to compare the results and quality of life of patients treated in our center for colon cancer, aged from 80 to 84 years (study group) compared to a control group (aged form 75 to 79 years of age). Morbidity, mortality, oncological results and quality of life were analyzed. Results: eighty-seven patients aged between 80 and 84 years of age (study group) were compared to a control group, which was formed by 91 patients aged from 75 to 79 years of age. There were no significant differences in technique and morbidity. Survival at 30 days, 90 days and at the end of follow-up (median 48 months) were similar in both groups. There were no differences in quality of life except for one item with regard to physical function (p = 0.0138). Conclusion: similar clinical results and quality of life were achieved after treating elderly patients with colon cancer with a multidisciplinary management approach

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Survival and quality of life after surgery for colorectal cancer in the elderly: a comparative study.

BACKGROUND: the aim of this study was to analyze the clinical results of the multidisciplinary management of elderly patients with colorectal cancer in a single center and to describe postoperative quality of life. METHODS: a comparative study was designed to compare the results and quality of life of patients treated in our center for colon cancer, aged from 80 to 84 years (study group) compared to a control group (aged form 75 to 79 years of age). Morbidity, mortality, oncological results and quality of life were analyzed. RESULTS: eighty-seven patients aged between 80 and 84 years of age (study group) were compared to a control group, which was formed by 91 patients aged from 75 to 79 years of age. There were no significant differences in technique and morbidity. Survival at 30 days, 90 days and at the end of follow-up (median 48 months) were similar in both groups. There were no differences in quality of life except for one item with regard to physical function (p = 0.0138). CONCLUSION: similar clinical results and quality of life were achieved after treating elderly patients with colon cancer with a multidisciplinary management approach.

Unidades funcionales para el manejo quirúrgico del paciente geriátrico / Multidisciplinary unit for the surgical management of geriatric patient

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Long-Term Results of Serial Transverse Enteroplasty with Neovalve Creation for Extreme Short Bowel Syndrome: Report of Two Cases.

OBJECTIVE: The aim of this article was to determine whether serial transverse enteroplasty (STEP) and the creation of a new ileocecal valve in extreme short bowel syndrome (SBS) cases (<45 cm) is effective in intestinal adaptation and improvement of nutritional parameters and serum citrulline levels. PATIENTS AND METHODS: We present 2 cases of SBS treated with STEP. Enterectomy was performed for massive intestinal ischemia secondary to a gastrointestinal stromal tumor in the first case and to catastrophic antiphospholipid syndrome in the second. After enterectomy, the short residual bowel measured 34 cm in the first patient and 45 cm in the second. In both cases STEP, cholecystectomy, and gastrostomy were performed. In the first case a Brooke neovalve was created, and in the other the ileocecal valve was preserved. RESULTS: Both patients could finally be weaned off total parenteral nutrition (TPN) and gastrostomy feeding, maintaining a good nutritional status 1 year after surgery. CONCLUSIONS: In extreme SBS, a minimum length of 80-90 cm of functioning small bowel and an intact ileocecal valve are necessary. We plead for the use of STEP with preservation of the ileocecal valve or creation of a neovalve using the Brooke technique in order to achieve the ultimate goal, which is to wean patients off TPN. After a critical review of different surgical techniques, a treatment algorithm is proposed.

Reconstruccion de la mama con gel de plaquetas en la cirugia conservadora del cancer / Use of platelet gel in breast reconstruction after breast-conserving cancer surgery

Introducción: Con la finalidad de disminuir las deformidades de la mama después de la cirugía conservadora del cáncer, presentamos una nueva técnica de reconstrucción mamaria mediante la restitución del volumen mamario con gel de plaquetas. Pacientes y métodos Estudio piloto de 20 pacientes con cáncer de mama sometidas a tumorectomía a las que se aplicó en el espacio residual el gel obtenido por plaquetoaféresis de donante alogénico sano. A las pacientes se les realizó un seguimiento clínico, iconográfico e histológico, así como una valoración del resultado estético. Resultados La edad media fue de 50,5±8,65 años (rango 42-70 años) y la mediana del índice de comorbilidad de Charlson fue de 1,15±1,27 (rango 0-5). El volumen medio de la tumorectomía fue de 63,1±31,1ml (rango 30-160ml) y el volumen de restitución con el gel de plaquetas fue de 111,5±60,9ml (rango 40-250ml). Después de una mediana de seguimiento de medio de 17 meses, el 80% de las pacientes preservaron el volumen mamario y no fueron necesarias reintervenciones por afectación de los márgenes quirúrgicos ni se observaron recidivas. Conclusiones El gel de plaquetas permite restituir el volumen mamario ajustado al volumen de la tumorectomía, minimizando las retracciones y deformidades habituales de la cirugía conservadora, lo que permite realizar resecciones amplias con márgenes oncológicos de seguridad (AU)

Introduction: With the aim of decreasing breast defects after conservative cancer surgery, we present a new breast reconstruction technique using breast volume restitution with platelet gel. Patients and method: A pilot study was conducted on 20 breast cancer patients undergoing tumorectomy with placement a gel obtained by platelet pheresis of a healthy allogeneic donor in the surgical cavity. Patients had a clinical, photographic and histological follow-up, as well as an assessment of the aesthetic outcome. Results: The mean age was 50.5 8.6 years (range 42-70 years) and with a mean Charlson comorbidity index of 1.1 1.2 (range 0-5). The mean tumour volume was 63.1 31.1 ml(range 30-160 ml) and the mean restitution volume with platelet gel was 111.5 60.9 ml (range40-250 ml). After a mean follow-up of 17 months, 80% of the patients maintained the breast volume and no further operations were needed due to surgical margin involvement. No recurrences were observed in any patient. Conclusions: Platelet gel allows restitution of the breast volume adjusted to the tumorectomy volume, minimising the usual retractions and deformities after conservative surgery. It enables wide resections and safety margins (AU)

[Use of platelet gel in breast reconstruction after breast-conserving cancer surgery]. / Reconstrucción de la mama con gel de plaquetas en la cirugía conservadora del cáncer.

INTRODUCTION: With the aim of decreasing breast defects after conservative cancer surgery, we present a new breast reconstruction technique using breast volume restitution with platelet gel. PATIENTS AND METHOD: A pilot study was conducted on 20 breast cancer patients undergoing tumorectomy with placement a gel obtained by plateletpheresis of a healthy allogeneic donor in the surgical cavity. Patients had a clinical, photographic and histological follow-up, as well as an assessment of the aesthetic outcome. RESULTS: The mean age was 50.5±8.6 years (range 42-70 years) and with a mean Charlson comorbidity index of 1.1±1.2 (range 0-5). The mean tumour volume was 63.1±31.1 ml (range 30-160 ml) and the mean restitution volume with platelet gel was 111.5±60.9 ml (range 40-250 ml). After a mean follow-up of 17 months, 80% of the patients maintained the breast volume and no further operations were needed due to surgical margin involvement. No recurrences were observed in any patient. CONCLUSIONS: Platelet gel allows restitution of the breast volume adjusted to the tumorectomy volume, minimising the usual retractions and deformities after conservative surgery. It enables wide resections and safety margins.

Clinical outcome in patients with peripheral artery disease and renal artery stenosis.

BACKGROUND: There is controversy on the influence of renal artery stenosis on outcome in patients with peripheral artery disease. PATIENTS AND METHODS: The 12-month impact of renal artery stenosis on declining renal function, control of hypertension, and incidence of major cardiovascular events in 100 consecutive patients undergoing angiography for peripheral artery disease was evaluated. RESULTS: A total of 60 patients had renal artery stenosis: 32 mild, 16 moderate, and 12 severe stenosis. There were no significant differences in either the decline of renal function (2.7 +/- 18% vs 0.9 +/- 16%), control of hypertension (139 +/- 16 vs 139 +/- 22 mm Hg) or number of antihypertensive drugs (1.8 +/- 1.0 vs 1.6 +/- 0.8). Patients with renal artery stenosis had an increased incidence of major cardiovascular events (odds ratio: 2.3; 95% confidence interval: 1.03-5.4), but on multivariate analysis its influence disappeared. CONCLUSIONS: Patients with peripheral artery disease having renal artery stenosis had similar decline of renal function and control of hypertension. They had an increased incidence of major cardiovascular events, but it may be explained by the confounding effect of additional variables.

Bronchial stump infiltration after lung cancer surgery. Retrospective study of a series of 2994 patients.

The incidence of lung cancer has been increasing in developed countries since the mid-1990s. The main objective of this study is to determine if bronquial stump infiltration can affect survival in patients with lung cancer. For this purpose, we differentiate between carcinoma 'in situ' and invasive carcinoma. We included patients suffering from non-small cell lung cancer who underwent thoracothomy as treatment. The total number of patients was 2994. In this study, 80 patients out of the 2994 had bronchial stump affection. Eight patients were excluded thus a total of 72 patients were included, 52 of them had carcinoma 'in situ' and 20 invasive carcinoma. The global survival was 25 months. Patients with carcinoma 'in situ' had a median survival of 25 months as opposed to 21 months in patients with invasive carcinoma. We only found statistical significance when we compared the histology with the type of bronchial stump infiltration. We did not observe statistical significance in survival between carcinoma 'in situ' and invasive carcinoma bronchial stump infiltration (P=0.094). The only survival predictor variable is histology (adenocarcinoma), P=0.0001.

Cisplatin plus weekly CPT-11/docetaxel in advanced esophagogastric cancer: a phase I study with pharmacogenetic assessment of XPD, XRCC3 and UGT1A1 polymorphisms.

PURPOSE: A multicenter phase I trial to establish the recommended dose of CPT-11/docetaxel plus cisplatin in advanced esophagogastric cancer patients and to correlate the efficacy and toxicity with genetic polymorphisms in DNA repair genes (XPD and XRCC3) and the UGT1A1 gene. METHODS: Four dose levels with a fixed dose of cisplatin (60 mg/m(2)), day 1, and dose-escalation of CPT-11 (50-70 mg/m(2)) and docetaxel (25-30 mg/m(2)), days 1 and 8, every 3 weeks were planned. Polymorphisms of XPD (Asp312Asn and Lys751Gln), XRCC3 (Thr241Met) and UGT1A1*28 were examined in baseline peripheral blood. RESULTS: Twenty-eight patients were included at three different dose levels. Dose-limiting toxicities were febrile neutropenia and diarrhea; the recommended dose was established at CPT-11 60 mg/m(2) and docetaxel 25 mg/m(2) plus cisplatin 60 mg/m(2). Objective response was observed in 13 patients (50%). Median time to progression was 6.6 months, and median survival was 11.3 months. Median time to progression was 9.7 months for patients harboring the XRCC3 Met241Met genotype versus 8.4 months for patients with Thr241Met and 3.1 months for those with Thr241Thr (P = .04). CONCLUSIONS: CPT-11/docetaxel plus cisplatin is active in patients with advanced esophagogastric cancer. XRCC3 Met241Thr polymorphisms could be a useful marker to predict prognosis in patients treated with a cisplatin-based chemotherapy. However, these results are required to be confirmed with a great number of patients.

[Evaluation of splenic function by dynamic gammagraphy, study of pitted erythrocytes and submembranous vacuoles in patients with slight and severe splenic trauma receiving conservative treatment or splenectomy]. / Valoración de la función esplénica mediante gammagrafía dinámica y estudio de "pits" de la membrana eritrocitaria y de vacuolas submembranarias en los pacientes con traumatismo leve y grave de bazo tratados de forma conservadora o mediante esplenectomía.

BACKGROUND AND OBJECTIVE: The splenic function of patients followed by the Department of General and Digestive Surgery in the Hospital Universitari Germans Trias i Pujol (HUGTiP) from 1985 to 2003 for different degrees of splenic trauma according to the classification of the American Association for the Surgery of Trauma (AAST) 1994 was quantified and related to the treatment received (non surgical, total splenectomy with or without splenosis and splenectomy plus autotransplantation) to detect splenic dysfunction predisposing the development of postsplenectomy sepsis (PSS). PATIENTS AND METHOD: 43 patients underwent an isotopic study with dynamic splenic gammagraphy and pitted erythrocytes (Normarsky optics) and submembranous vacuoles (transmission electron microscopy) were evaluated. RESULTS: The non surgical group presented normal phagocytic and filtration function with the median speed of splenic enhancement being 3.46 Kcts/s2 (interval: 0.8-6.98). The percentage of pitted erythrocytes was 2% (0-8.8), the number of pits per erythrocyte was 0.03 (0-0.12) and the percentage of erythrocytes with 1, 2, 3 and 4 pits was 1.6%, 0.4%, 0% and 0%, respectively. The percentage of red cells with submembranous vacuoles was 2.55% (0-5.6), the number of vacuoles per red cell was 0.03 (0-0.06) and the percentage of red cells with 1, 2, 3 and 4 vacuoles was 2%, 0.2%, 0% and 0%, respectively. In the operated group, the splenic enhancement speed was 0.08 Kcts/s2 (0-1.75) (p < 0.0001). The percentage of pitted erythrocytes was 38% (0.2-64) (p < 0.0001), the number of pits per erythrocyte was 0.86 (0-1.8) (p < 0.0001) and the percentage of erythrocytes with 1,2,3 and 4 pits was 16.39%, 7.2%, 3.59% and 2.52%, respectively (p < 0.0001). The percentage of red cells with submembranous vacuoles was 11.2% (1.8-31.9) (p = 0.0006); the number of vacuoles per cell was 0.16 (p = 0.0022) and the percentage of red cells with 1, 2, 3 and 4 vacuoles was 6.51%, 1.73%, 0.4% and 0.2%, respectively (p = 0.0246, 0.0010, < 0.0001 and 0.0002, respectively). CONCLUSIONS: Splenic function of patients with a history of splenic trauma receiving conservative treatment is normal, independently of the degree of the lesion, thereby reinforcing the use of this therapeutic approach to avoid the development of postsplenectomy sepsis. In the patients treated with splenectomy, with or without splenosis, splenic function was absent or very altered being partially conserved in cases treated with splenectomy plus autotransplantation.

Valoración de la función esplénica mediante gammagrafía dinámica y estudio de «pits» de la membrana eritrocitaria y de vacuolas submembranarias en los pacientes con traumatismo leve y grave de bazo tratados de forma conservadora o mediante esplenectomía / Evaluation of splenic function by dynamic gammagraphy, study of pitted erythrocytes and submembranous vacuoles in patients with slight and severe splenic trauma receiving conservative treatment or splenectomy

Fundamento y objetivo: Cuantificar la función esplénica de los pacientes controlados en el Servicio de Cirugía General y Digestiva del Hospital Universitari Germans Trias i Pujol (HUGTiP) desde 1985 hasta 2003 tras haber sufrido diferentes grados de lesión traumática del bazo según la clasificación de la American Association for the Surgery of Trauma (AAST) del año 1994 y relacionarla con el tratamiento recibido (no operatorio, esplenectomía total con o sin esplenosis y esplenectomía más autotrasplante), con la finalidad de detectar disfunciones esplénicas que predispongan al desarrollo de la sepsis tras la esplenectomía. Pacientes y método: Se ha realizado a 43 pacientes un estudio isotópico con gammagrafía esplénica «dinámica», estudio de «pits» de la membrana eritrocitaria (óptica de Nomarsky) y de vacuolas submembranarias (microscopia electrónica de transmisión). Resultados: El grupo de no operados presenta una función normal de fagocitosis y filtración, con una mediana de velocidad de captación esplénica de 3,46 Kcts/s2 (intervalo, 0,8-6,98). El porcentaje mediano de «pits» de membrana fue del 2% (intervalo, 0-8,8%); el número de «pits» por hematíes, de 0,03 (intervalo, 0-0,12), y el porcentaje de hematíes con 1, 2, 3 y 4 «pits», del 1,6, el 0,4, el 0 y el 0%, respectivamente. El porcentaje mediano de hematíes con vacuolas submembranarias fue el 2,55% (intervalo, 0-5,6%); el número de vacuolas por hematíe, de 0,03 (intervalo, 0-0,06), y el porcentaje de hematíes con 1, 2, 3 y 4 vacuolas, del 2, el 0,2, el 0 y el 0%, respectivamente. En el grupo operado, la velocidad mediana de captación esplénica fue de 0,08 Kcts/s2 (intervalo, 0-1,75; p < 0,0001); el porcentaje mediano de «pits» de membrana, del 38% (intervalo, 0,2-64; p < 0,0001); el número mediano de «pits» por hematíe, de 0,86 (intervalo, 0-1,8; p < 0,0001), y el porcentaje de hematíes con 1, 2, 3 y 4 «pits», del 16,39, el 7,2, el 3,59 y el 2,52%, respectivamente (p < 0,0001). La mediana del porcentaje de hematíes con vacuolas submembranarias fue del 11,2% (intervalo, 1,8-31,9; p = 0,0006); el número mediano de vacuolas por hematíe, de 0,16 (p = 0,0022), y el porcentaje de hematíes con 1, 2, 3 y 4 vacuolas, del 6,51, el 1,73, el 0,4 y el 0,2%, respectivamente (p = 0,0246; p = 0,0010; p < 0,0001, y p = 0,0002, respectivamente). Conclusiones: La función esplénica de los pacientes con antecedentes de traumatismo esplénico tratados de forma conservadora es normal, independientemente del grado de la lesión. Ello refuerza la conveniencia de aplicar de entrada esta actitud a todos los protocolos para intentar evitar la sepsis tras la esplenectomía. En los casos tratados con esplenectomía, con o sin esplenosis, la función esplénica está ausente o muy alterada, mientras que en los casos tratados con esplenectomía y autotrasplante está parcialmente conservada

Background and objective: The splenic function of patients followed by the Department of General and Digestive Surgery in the Hospital Universitari Germans Trias i Pujol (HUGTiP) from 1985 to 2003 for different degrees of splenic trauma according to the classification of the American Association for the Surgery of Trauma (AAST) 1994 was quantified and related to the treatment received (non surgical, total splenectomy with or without splenosis and splenectomy plus autotransplantation) to detect splenic dysfunction predisposing the development of postsplenectomy sepsis (PSS). Patients and method: 43 patients underwent an isotopic study with dynamic splenic gammagraphy and pitted erythrocytes (Normarsky optics) and submembranous vacuoles (transmission electron microscopy) were evaluated. Results: The non surgical group presented normal phagocytic and filtration function with the median speed of splenic enhancement being 3.46 Kcts/s2 (interval: 0.8-6.98). The percentage of pitted erythrocytes was 2% (0-8.8), the number of pits per erythrocyte was 0.03 (0-0.12) and the percentage of erythrocytes with 1,2,3 and 4 pits was 1.6%, 0.4%, 0% and 0%, respectively. The percentage of red cells with submembranous vacuoles was 2.55% (0-5.6), the number of vacuoles per red cell was 0.03 (0-0.06) and the percentage of red cells with 1,2,3 and 4 vacuoles was 2%, 0.2%, 0% and 0%, respectively. In the operated group, the splenic enhancement speed was 0.08 Kcts/s2 (0-1.75) (p < 0.0001). The percentage of pitted erythrocytes was 38% (0.2-64) (p < 0.0001), the number of pits per erythrocyte was 0.86 (0-1.8) (p < 0.0001) and the percentage of erythrocytes with 1,2,3 and 4 pits was 16.39%, 7.2%, 3.59% and 2.52%, respectively (p < 0.0001). The percentage of red cells with submembranous vacuoles was 11.2% (1.8-31.9) (p = 0.0006); the number of vacuoles per cell was 0.16 (p = 0.0022) and the percentage of red cells with 1,2,3 and 4 vacuoles was 6.51%, 1.73%, 0.4% and 0.2%, respectively (p = 0.0246, 0.0010, < 0.0001 and 0.0002, respectively). Conclusions: Splenic function of patients with a history of splenic trauma receiving conservative treatment is normal, independently of the degree of the lesion, thereby reinforcing the use of this therapeutic approach to avoid the development of postsplenectomy sepsis. In the patients treated with splenectomy, with or without splenosis, splenic function was absent or very altered being partially conserved in cases treated with splenectomy plus autotransplantation