Ch 83 spleen Flashcards
Phipps JAVMA 2020
Postoperative thrombocytosis and
thromboelastographic evidence of hypercoagulability
in dogs undergoing splenectomy for splenic masses
Follow up 2 weeks post splenectomy
Blood samples for platelet counts and thromboelastography were obtained
at induction of anesthesia (day 0) prior to splenectomy and on days 2, 7,
and 14.
RESULTS
Mean platelet counts were 167.9 X 103/μL, 260.4 X 103 μ/L, 715.9 X 103/
μL, and 582.2 X 103/μL on days 0, 2, 7, and 14, respectively, and were
significantly higher at all postoperative assessment points than on day 0.
Thrombocytosis was observed in 3% (1/34), 6% (2/33), 81% (21/26), and
69% (18/26) of dogs on days 0, 2, 7, and 14. Platelet counts > 1,000 X 103/
μL were observed in 1 dog on day 2 and in 5 dogs on day 7. One or more
thromboelastography values suggestive of hypercoagulability were observed
in 45% (15/33), 84% (26/31), 89% (24/27), and 84% (21/25) of dogs on days
0, 2, 7, and 14.
At each assessment point, higher platelet counts were correlated
with thromboelastography values suggestive of hypercoagulability.
CONCLUSIONS AND CLINICAL RELEVANCE
Marked thrombocytosis and thromboelastography values suggestive of hypercoagulability
were common during the first 2 weeks after splenectomy
for the dogs of this study. If present, hypercoagulability could increase the
risk for development of postsplenectomy thrombotic conditions such as
portal system thrombosis and pulmonary thromboembolism.
Burgess JAVMA 2021
Development and validation of a multivariable model
and online decision-support calculator to aid
in preoperative discrimination of benign
from malignant splenic masses in dogs
RESULTS
The final multivariable model contained 8 clinical variables used to estimate
splenic malignancy probability: serum total protein concentration, presence
(vs absence) of ≥ 2 nRBCs/100 WBCs, ultrasonographically assessed splenic
mass diameter, number of liver nodules (0, 1, or ≥ 2), presence (vs absence)
of multiple splenic masses or nodules, moderate to marked splenic mass
inhomogeneity, moderate to marked abdominal effusion, and mesenteric,
omental, or peritoneal nodules. Areas under the receiver operating characteristic
curves for the development and validation populations were 0.80
and 0.78, respectively.
CONCLUSIONS AND CLINICAL RELEVANCE
The online calculator (T-STAT.net or T-STAT.org) developed in this study
can be used as an aid to estimate the probability of malignancy in dogs with
splenic masses and has potential to facilitate owners’ decisions regarding
splenectomy.
Masyr JAVMA 2021
Retrospective evaluation of thrombocytopenia
and tumor stage as prognostic indicators
in dogs with splenic hemangiosarcoma
RESULTS
Stage 3 HSA was identified as a negative prognostic indicator of PFI (HR,
6.6) and OST (HR, 4.5). Perioperative thrombocytopenia was similarly associated
with shorter PFI (HR, 2.2) and OST (HR, 2.0). Results for Hct correlated
(ρ = 0.58) with those for platelet count, and although our findings
did not indicate a notable association between anemia and shorter PFI, such
could not be ruled out.
Millar JAVMA 2022
Premature death in dogs with nontraumatic
hemoabdomen and splenectomy with benign
histopathologic findings
RESULTS
Histopathologic findings indicated malignancy in 144 of the 197 (73.1%) dogs with nontraumatic hemoabdomen. Hemangiosarcoma
was diagnosed in 126 dogs (87.5% of those with malignancies and 64.0% of all dogs). Nine of 53 (17%) dogs with
nonmalignant histopathologic findings had an adverse outcome and premature death, with an MST of 49 days. Risk factors for
this outcome included low plasma total solids concentration, an elevated hemangiosarcoma likelihood prediction score, and a
medium or high hemangiosarcoma likelihood prediction score category.
CONCLUSIONS AND CLINICAL RELEVANCE
This study showed that there is a group of dogs with nontraumatic hemoabdomen due to splenic disease that have nonmalignant
histopathologic findings after splenectomy, but nonetheless suffer an adverse outcome and die prematurely of a suspected malignancy.
Further evaluation of potential at-risk populations may yield detection of otherwise overlooked malignancies
Story Vet Surg 2020
Outcomes of 43 small breed dogs treated for splenic
hemangiosarcoma
Results: The overall median ST was 116 days and 97 days for small and large
breed dogs, respectively. The ST for dogs treated with surgery and chemotherapy
was 207 and 139 days for small and large breed dogs, respectively. The disease-free
interval (DFI) was 446 and 80 days for small and large breed dogs, respectively.
Dog size was associated with DFI (P = .02) but not with ST (P = .09). The presence
of metastasis at diagnosis was associated with decreased ST in small
(P = .03) and large (P = .0009) breed dogs. Administration of chemotherapy
(P = .02) was associated with increased ST (P = .02) in small breed dogs.
Conclusion: The ST was not different in small and large breed dogs with
splenic hemangiosarcoma treated with splenectomy and chemotherapy.
Clinical significance: Prognosis remains poor despite aggressive therapies in
small and large breed dogs.
Pannisidi Vet Surg 2021
Development of perioperative premature ventricular
contractions as an indicator of splenic hemangiosarcoma
and median survival times
Results: Eighteen out of 45 (40%) dogs were diagnosed with HSA with 13/18
(72%) dogs having VPCs postoperatively (P = .02). Ruptured splenic HSA and
VPCs were noted in 13 dogs (P = .73). An association between dogs with and
without VPCs diagnosed with HSA and median survival times could not be
established.
Conclusion: Postoperative VPCs were more likely with splenic HSA. Splenic
masses were more likely to be HSA if ruptured but less likely to develop VPCs.
Development of VPCs does not affect median survival times.
Clinical Significance: Development of postoperative VPCs may be a potential
indicator of HSA, however, this warrants further investigations. Development
of VPCs does not have a deleterious effect on survival.
Cudney JAVMA 2021
Diagnostic utility of abdominal ultrasonography
for evaluation of dogs with nontraumatic hemoabdomen:
94 cases (2014–2017)
Differences were identified between AUS and surgical or necropsy findings
for 51 of 94 (54%) dogs. Splenic masses were most commonly identified as
the cause of hemoabdomen. Sensitivity of AUS was 87.4%, 37.3%, and 31.3%
for masses in the spleen, liver, and mesentery, respectively. Five dogs had
more lesions identified with AUS than were found on gross evaluation; 0 of 6
dogs with peritoneal diffuse nodular metastasis had lesions detected by AUS.
CONCLUSIONS AND CLINICAL RELEVANCE
In this sample of dogs, the utility of AUS to detect grossly identifiable lesions
in dogs with nontraumatic hemoabdomen was limited, with the highest and
lowest sensitivity found for splenic masses and diffuse nodular metastasis,
Fairfield JAVMA 2023
Minimally invasive splenectomy is associated
with a low perioperative complication rate
and short operative time in cats
13 spayed females and 4 neutered males were included, with a median age of 144 months (48 to 196 months). Seven cats underwent total laparoscopic splenectomy (TLS), with 1 cat requiring conversion from TLS to laparoscopic-assisted splenectomy (LAS) due to splenomegaly and an additional cat requiring conversion from TLS to open splenectomy due to uncontrollable splenic capsular hemorrhage. Ten cats underwent LAS, with 1 cat requiring conversion to open splenectomy due to splenomegaly. Additional procedures were performed in 13 cats, with the most common being liver biopsy in 10 cats. Median operative times were 50 minutes (45 to 90 minutes) for TLS and 35 minutes (25 to 80 minutes) for LAS. An intraoperative complication occurred in 1 cat. All but 1 cat survived to discharge. Median follow-up time was 234 days (18 to 1,761 days), with 15 of 16 cats confirmed alive at 30 days and 9 of 16 cats alive at 180 days postoperatively.
CLINICAL RELEVANCE
Minimally invasive splenectomy in this cohort of cats was associated with short operative times and a low perioperative complication rate. Veterinary surgeons may consider minimally invasive splenectomy as an efficient and feasible technique in the treatment of splenomegaly or modestly sized splenic masses for diagnostic and therapeutic purposes in cats.
Hillier JAVMA 2024
Improved predictability is needed for calculators
used to preoperatively determine the etiology
of splenic masses in dogs: an external validation study
of the HeLP score and T-STAT
RESULTS
The HeLP score included 141 dogs; hemangiosarcoma was diagnosed in 87 (61.7%) dogs. The median cumulative HeLP score was 51 (range, 17 to 82; IQR, 39 to 58) for dogs with hemangiosarcoma and 28 (range, 0 to 70; IQR, 17 to 41) for dogs without hemangiosarcoma. The categorical HeLP score was low (28; 32.2%), medium (31; 35.6%), and high (28; 32.2%) for dogs with hemangiosarcoma and was low (41; 75.9%), medium (9; 16.7%), and high (4; 7.4%) for dogs without hemangiosarcoma. The AUC of the cumulative and categorical HeLP scores for diagnosis of hemangiosarcoma were 0.79 (95% CI, 0.71 to 0.86) and 0.73 (95% CI, 0.65 to 0.82), respectively. The T-STAT included 181 dogs. Lesions were benign in 95 (52.5%) and malignant in 86 (47.5%) dogs. The median T-STAT score was 62% (range, 5% to 98%; IQR, 36% to 77%) for dogs with malignant lesions and 38% (range, 5% to 91%; IQR, 24% to 59%) for dogs with benign lesions. The T-STAT had an AUC of 0.68 (0.60 to 0.76) for diagnosis of malignancy.
CLINICAL RELEVANCE
The HeLP score had acceptable performance, and the T-STAT had poor performance for diagnosis prediction. A tool with excellent or outstanding discrimination is needed to more reliably predict the presence of hemangiosarcoma or a malignant lesion preoperatively.
Clarke JSAP 2020
Clinical utility of liver biopsies in dogs
undergoing splenectomy
Malignant splenic neoplasia was detected in 50 of 113 (44.2%) of the dogs undergoing splenectomy.
Neoplastic liver disease was detected on biopsy from 1 of 40 (2.5%) dogs with a grossly
normal liver and from 20 of 69 (28.9%) dogs with a grossly abnormal liver. Dogs with a grossly abnormal
liver had a ~ 16 times (95% CI: 2.5-170) higher chance of being diagnosed with liver neoplasia on
biopsy. Haemoabdomen was also associated with an increased likelihood of liver neoplasia on biopsy
at the time of splenectomy.
Clinical Significance: A liver biopsy taken from grossly normal liver is a low-yield diagnostic test but liver
biopsy is recommended following splenectomy if the liver appears abnormal at surgery.
Menard JAVMA 2023
Assessing major influences on decision-making
and outcome for dogs presenting emergently
with nontraumatic hemoabdomen
RESULTS
Owners reported QOL as the most important factor influencing their decision-making (92%), followed by risk of cancer (57%) or time remaining with their pet (56%). QOL scores were significantly higher with surgery versus those with palliative care (P = .007). Median survival time (MST) was 213 days with surgery and 39 days with palliative care (P = .049). Survival benefit of surgery was lost when considering only dogs with malignant histopathology (MST, 81 days; P = .305). Owners were more likely to be satisfied when they chose surgery over either euthanasia or palliative care (P = .039). Thirty-four owners (26%) second-guessed or were unsure of their decision.
CLINICAL RELEVANCE
Surgery resulted in the longest MST with greater perceived QOL and owner satisfaction compared with both palliative care and euthanasia and should therefore be considered highly. The importance of malignancy and survival time on owners’ decisions, along with the negative impact of metastasis on survival, underscores the importance of timely preoperative staging. The rate of second-guessing highlights the need for standardization of NTH discussions including treatment options and potential outcomes in order to effectively and efficiently guide treatment of patients with this common presentation.
Schick JAVMA 2023
Evaluation of the validity of the double two-thirds rule for diagnosing hemangiosarcoma in dogs with
nontraumatic hemoperitoneum due to a ruptured splenic mass: a systematic review
RESULTS
In total, 2,390 unique articles were identified, with 66 articles meeting the criteria for full-text review and 14 articles included for analysis. A total of 1,150 dogs were evaluated, with 73.0% (840/1,150) of dogs being diagnosed with a malignant splenic lesion and 27.0% (310/1,150) being diagnosed with a benign splenic lesion. Of the malignancies, 87.3% (733/840) were hemangiosarcoma. Levels of evidence were low, and bias was high as most included studies were retrospective case series.
CLINICAL RELEVANCE
The double two-thirds rule should be refined when evaluating dogs with nontraumatic hemoperitoneum from a ruptured splenic mass, with more dogs being diagnosed with a malignancy and hemangiosarcoma specifically than the double two-thirds rule indicates. These findings may be useful in an emergency setting to guide owners on potential diagnoses for dogs with nontraumatic hemoperitoneum due to a ruptured splenic mass. However, there remains a portion of these dogs with benign conditions and nonhemangiosarcoma malignancies that may have a good long-term prognosis compared to dogs with hemangiosarcoma. Studies with higher levels of evidence, lower risks of bias, and large case numbers are needed in the literature.
Kuvaldina Vet Surg 2018
Influence of multiple reuse and resterilization cycles on the
performance of a bipolar vessel sealing device (LigaSure)
intended for single use
Results: Vascular seals created with the Small Jaw handset failed at a mean (95%
CI) of 17.2 cycles (9.6-24.8) and a minimum of 10 cycles. Vascular seals created
with the Impact failed at a mean of 20 cycles (18.4-21.6) and a minimum of
17 cycles. The majority of seal failures (73%; 95% CI 39%-94%) immediate leaked
during vessel filling. The rate of vascular seal failure increased after the initial failure.
Failure was associated with histologic disparities in tissue apposition.
Conclusion: Repeated use and resterilization resulted in failure of the vascular seal
due to inadequate tissue apposition after a minimum of 10 cycles.
Clinical significance: Surgeons reusing and resterilizing LigaSure handsets
(ForceTriad platform) should consider discarding handsets after 9 cycles for the
Small Jaw and after 16 cycles for the Impact. Handsets should be immediately discarded
after any intraoperative identification of vascular seal failure.
McGaffey JAVMA 2022
Complications and outcomes associated
with laparoscopic-assisted splenectomy in dogs
RESULTS
LAS was performed for treatment of a splenic mass (124/136 [91%]), immune-mediated disease (7/136 [5%]), splenomegaly (4/136 [3%]), or immune-mediated disease in conjunction with a splenic mass (1/136 [1%]). Median splenic mass size was 1.3 cm3/kg body weight. Conversion to open laparotomy occurred in 5.9% (8/136) of dogs. Complications occurred in 78 dogs, with all being grade 2 or lower. Median surgical time was 47 minutes, and median postoperative hospital stay was 28 hours. All but 1 dog survived to discharge, the exception being postoperative death due to a suspected portal vein thrombus.
CLINICAL RELEVANCE
In the dogs of this report, LAS was associated with low rates of major complications, morbidity, and mortality when performed for a variety of splenic pathologies. Minimally invasive surgeons can consider the LAS technique to perform total splenectomy in dogs without hemoabdomen and with spleens with modest-sized splenic masses up to 55.2 cm3/kg, with minimal rates of complications, morbidity, and mortality
Michael JAVMA 2023
Perioperative ventricular arrhythmias are increased with hemoperitoneum and are associated with
increased mortality in dogs undergoing
splenectomy for splenic masses
RESULTS
VAs occurred in 138 (44.8%) dogs (126/308 [40.9%] postoperative, 51/308 [16.6%] intraoperative, 26/308 [8.4%] preoperative), with 50/308 (16.2%) dogs having more than one type of VA. Increasing heart rate and body weight, decreasing PCV and platelet count, hemoperitoneum, receipt of a transfusion, and diagnosis of hemangiosarcoma were associated with the presence of intra- and postoperative VAs on univariable analysis (all P < .001). On multivariable analysis, hemoperitoneum (P < .001 , < .001), increasing body weight (P = .026, < .001), and increasing heart rate (P = .028, < .001) were significant for intra- and postoperative VAs, respectively. Twenty dogs died (20/308 [6.5%]; 14/138 [10.1%] with VAs, 6/170 [3.5%] without VAs). Intra- and postoperative VAs were associated with in-hospital mortality (P = .009, .025, respectively).
CLINICAL RELEVANCE
Perioperative VAs were common and odds of VAs were increased with hemoperitoneum, increasing heart rate, and increasing body weight. Presence of VAs increased the odds of in-hospital mortality. Despite this, the overall in-hospital mortality rate was low (6.5%), indicating a good prognosis for survival of surgery in dogs with splenic masses, regardless of the presence of VAs or hemoperitoneum.
