Partial splenectomy after preoperative embolization in a patient with metastatic melanoma – A case report. (March 2022)

• Record Type: Journal Article
• Authors: Hauge, Tobias; Dorenberg, Eric; Goscinski, Mariusz
• Is Part Of: International journal of surgery case reports. Volume 92(2022)
• Publication Date: 2022-03
• Subjects: PS partial splenectomy -- DSA digital subtraction angiography -- PVA polyvinyl alcohol -- RFA radiofrequency ablation; Partial splenectomy -- Superselective embolization -- Melanoma -- Splenic metastasis -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2022.106837
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction and importance: There is lack of evidence regarding the best treatment option for metastatic melanoma. In patients with a single splenic metastasis, preoperative superselective embolization followed by partial splenectomy (PS) could be a feasible treatment strategy to preserve splenic function and hopefully reduce the risk of postoperative bleeding. To our knowledge, this two-step procedure has yet not been published in patients with splenic metastasis. Case presentation: We present the case of a 73-year-old man with stage IV melanoma consisting of a single splenic metastasis located at the lower pole. Four days prior to surgery, the patient underwent percutaneous superselective embolization of the segmental arteries going to the lower splenic pole. Subsequent, PS was performed using an upper midline laparotomy were a clearly visible tumor was found at the devascularized lower third of the spleen. The splenic parenchyma was divided using an energy device and hemostasis was secured with diathermia and a hemostatic patch. The patient had an uncomplicated recovery and was discharged home on postoperative day 8. Histology revealed an 8 mm, partly necrotic metastasis from a melanoma. There were no signs of recurrency at his last control four months postoperative. Clinical discussion: There are no guidelines on how splenic metastasis from melanoma are to be removed, nor any literature on postoperative splenic function or survival after PS. Conclusion: Superselective embolization followed by PS for metastatic melanoma could be a feasible treatment approach in highly selective patients where there is a strong desire to preserve splenic function. Highlights: Total splenectomy is associated with an increased risk of infections, thromboembolism and certain malignancies Partial splenectomy (PS) may be considered to preserve splenic function in cases where a splenic lesion is to be removed Preoperative superselective arterial embolization can be used to devascularize the relevant splenic segment prior to PS To our knowledge, superselective splenic embolization followed by PS has not been published in patients with splenic metastasis