Spleen Tumor Surgery in Uberlândia-MG

In most cases, spleen lesions are asymptomatic and are discovered incidentally on imaging studies performed for another reason. When present, signs include discomfort or pain in the left upper quadrant of the abdomen, early satiety, a palpable mass below the left rib cage, and an enlarged spleen (splenomegaly). Fever, night sweats, and unintentional weight loss (B symptoms) may suggest lymphoma and warrant medical evaluation.

Initial workup usually includes abdominal ultrasound and contrast-enhanced computed tomography, which characterize the lesion's size, location, and relationship to neighboring structures; magnetic resonance imaging may complement the evaluation in selected cases. Percutaneous biopsy of the spleen is avoided in most cases due to the risk of bleeding — definitive diagnosis is usually confirmed through analysis of the surgical specimen, or through lymph node or bone marrow biopsy when lymphoma is suspected.

Operating room time varies depending on the surgical approach and whether the splenectomy is performed alone or combined with resection of another organ, such as the pancreas or stomach. An isolated laparoscopic or robotic splenectomy usually takes between 1.5 and 3 hours; when combined with a distal pancreatectomy or gastrectomy, surgical time is longer. These figures are general estimates and may vary according to each patient's anatomic particularities.

Splenectomy is performed under general anesthesia, with the patient fully sedated and monitored by an anesthesiology team throughout the procedure. In some cases, a regional or epidural analgesic block is added as a complementary strategy for immediate postoperative pain control. The choice of anesthetic technique is determined jointly by the surgeon and the anesthesiologist, taking into account the patient's clinical status.

For laparoscopic or robotic surgery, hospitalization usually ranges from 2 to 4 days, with discharge after resumption of oral diet and adequate pain control. When splenectomy is performed via an open approach or associated with more extensive pancreatic or gastric resections, the hospital stay tends to be longer. The exact length of stay depends on each patient's clinical course and is determined by the care team.

Postoperative pain is expected and varies according to the surgical approach: laparoscopic and robotic procedures tend to cause less pain than the open approach, due to less trauma to the abdominal wall. Pain is managed with analgesics and, when necessary, anti-inflammatory medication, following a protocol adjusted to each patient's course. The intensity and duration of discomfort vary from person to person and should be discussed with the medical team.

Use of an abdominal drain is not routine in isolated splenectomy, but may be indicated when the procedure is combined with a distal pancreatectomy, due to the risk of pancreatic fistula, allowing monitoring of any fluid collection or leakage. A urinary catheter and, occasionally, a nasogastric tube may be used during the procedure and removed within the first few days. The need for and duration of these devices are assessed on an individual basis.

With the laparoscopic approach, three to five small incisions of about 1 cm are left, distributed across the abdomen; the robotic approach follows a similar pattern. With the open approach — more common when splenectomy is combined with larger oncologic resections — the incision is usually midline or left subcostal, and more extensive. The choice of approach takes into account the size of the spleen, the presence of adhesions, and the extent of the associated surgery.

For laparoscopic or robotic splenectomy, return to light activities usually occurs between 2 and 3 weeks; more intense physical activity or activity requiring abdominal effort is resumed gradually, generally after 4 to 6 weeks. When surgery is combined with larger resections or performed via an open approach, the recovery period tends to be longer. The definitive timeline is individualized according to the course of each case.

In addition to the general risks of any abdominal surgery, spleen removal increases susceptibility to serious infections caused by encapsulated bacteria (pneumococcus, meningococcus, Haemophilus influenzae) — which is why vaccination is recommended before elective surgery — and may transiently raise platelet counts, with a risk of venous thrombosis. Intraoperative bleeding is also a concern due to the organ's vascularity. Contraindications and the ideal timing of surgery are assessed according to each patient's overall clinical status and coagulation profile.

The need for complementary treatment depends on the cause of the splenic lesion: in lymphoma, chemotherapy is usually the mainstay of treatment, with splenectomy playing a diagnostic role or a role in symptom control; when the spleen is removed together with a pancreatic or gastric tumor, the indication for neoadjuvant or adjuvant chemotherapy follows the protocol for the primary tumor. These decisions are made by a multidisciplinary team, including a clinical oncologist, hematologist, and radiation oncologist as needed.