Autotransplantation of Splenic Tissue in Surgical Patients

The research is devoted to the problem of autotransplantation of splenic tissue in surgical patients who have undergone splenectomy, with the aim of preventing postoperative complications and preserving the vital functions of the spleen. A new method of autotransplantation of splenic tissue into the retroperitoneal space has been developed and tested in patients with splenic trauma and gastric cancer. The effectiveness of the method was evaluated using ultrasonographic and computed tomographic monitoring of the autograft status in the early and late postoperative periods. Data on regeneration of the autograft tissue were obtained, demonstrating the feasibility of preserving immunological and hematological functions of the spleen after its removal.

At present, an increasing number of patients undergo splenectomy. This is primarily due to the rise in trauma rates. Among abdominal organ injuries, splenic trauma ranks third and accounts for 25–50% according to various authors [12, 13, 22, 37, 61, 89, 90, 108, 112, 225]. The increase in the number of splenectomies is associated with a rise in the number of surgical interventions on abdominal organs, as well as an increase in their aggressiveness [15, 56]. Splenectomy is performed for therapeutic purposes when the benefit of the operation outweighs the risk of complications associated with it: in cases of splenomegaly, hypersplenism, certain oncological hematological diseases, hemolytic anemias, and thrombocytopenias [31, 118, 226]. Splenectomy is especially frequently performed in the surgical treatment of gastric cancer, which is associated with the "principle of radicalism" adopted in oncology [48, 77, 81, 91, 100, 114, 115, 122, 161, 198, 234].

Recent studies have shown that the spleen performs a number of vital functions in the body: immunological; regulation of the life activity of formed blood elements; synthesis of blood coagulation factors; iron exchange; and a number of others [14, 89, 109, 121, 150, 152, 158, 169, 219, 222]. This necessitates the search for a less aggressive surgical tactic in the case of splenic trauma, particularly when the trauma is iatrogenic in nature. The main difficulty in splenic injuries is achieving reliable hemostasis. To solve this problem, a large number of sutures, auto-, xeno-, and synthetic materials have been proposed that increase the reliability of the suture. A whole range of physical effects is applied: ultrasonic and laser wound treatment, partial ligation or embolization of the splenic artery [1, 2, 12, 21, 29, 40, 49, 68, 71, 88, 89, 90, 99, 127, 128, 133]. However, in a certain surgical situation, particularly in oncological patients, it is not possible to preserve the spleen. An alternative to organ-preserving operations in such cases became autotransplantation of splenic tissue. A large number of autotransplantation methods have been proposed, which differ in the site of transplantation, the size of the transplanted fragments, and the methods of splenic tissue processing [6, 13, 22, 39, 60, 62, 74, 79, 89, 190, 193]. The variety of techniques indicates that the results of autotransplantation are far from satisfactory, and certain aspects, in particular dynamic monitoring of the autograft status, and the use of autotransplantation of splenic tissue in extended operations for neoplasms of the stomach and other abdominal organs, are insufficiently covered in the literature.

Studying the possibility of expanding the implementation of autotransplantation of splenic tissue in surgical practice will allow reducing the number of early postoperative complications and improving the quality of life of patients in the late period.

Objective of the Work

The objective of the work is to improve the treatment outcomes of surgical patients who have undergone splenectomy and who have had autotransplantation of splenic tissue performed for the prevention of postoperative complications.

Main Tasks of the Work

1. To conduct an analysis of postoperative complications in patients after splenectomy.

2. To develop indications and contraindications for autotransplantation of splenic tissue in surgical patients.

3. To improve the method of autotransplantation of splenic tissue in surgical patients.

4. To study the possibility of autotransplantation of splenic tissue during operations for gastric cancer.

5. To study the possibility of dynamic monitoring of the state of the splenic tissue autograft in the postoperative period.

Scientific Novelty

Indications were determined and a new method of performing autotransplantation of splenic tissue for abdominal trauma and gastric cancer was developed.

The results of the developed autotransplantation method were investigated in the early and late postoperative periods. The effectiveness of the proposed method of preserving splenic function in the prevention of postsplenectomy hyposplenism syndrome was evaluated using ultrasonography and computed tomography. For the first time, investigation of the splenic tissue autograft in the postoperative period by spiral computed tomography was performed.

Practical Significance of the Work

The outcomes of surgical treatment of patients with abdominal trauma and patients with gastric cancer have been improved.

A method for preserving functioning splenic tissue during radical surgical intervention for gastric cancer has been developed, with preservation of the requirements of ablation.

The proposed method of preserving splenic function is an alternative to splenectomy in cases of splenic trauma and abdominal pathological processes that exclude the use of traditional methods of surgical prevention of the postsplenectomy syndrome. A method for evaluating the state of the autograft using ultrasonography and computed tomography has been developed.

Implementation in Practice

The developed method of autotransplantation of splenic tissue into the retroperitoneal space is applied in the department of abdominal oncology of the Lipetsk Regional Oncological Dispensary, in the surgical department of the Clinical Medical-Sanitary Unit of OAO HJIMK, Lipetsk, and in the Regional Clinical Hospital of Lipetsk.

The results of the dissertation research are used in the educational process at the Department of Surgical Diseases No. 1 of the Faculty of Advanced Training and Professional Retraining (FPK i PPS) of VGMА.

Based on the materials of the work, a Patent for Invention No. 2162659 "Method of Autotransplantation of Splenic Tissue" was obtained, along with 3 certificates of rationalization proposals.

Main Propositions to Be Defended

Autotransplantation of splenic tissue into the retroperitoneal space is no less effective than the traditional method of autotransplantation into the greater omentum and allows preservation of the vital functions of the spleen after splenectomy. The advantage of this method is that it can be applied in oncological patients, as well as that this method allows easy monitoring of the structural state of the autograft in the early and late postoperative periods.

Autotransplantation of splenic tissue into the retroperitoneal space in oncological patients reduces the number of purulent-septic complications in the early postoperative period.

Autotransplantation of splenic tissue into the retroperitoneal space in oncological patients does not increase the risk of tumor metastasis in the early or late period.

Regeneration of splenic tissue after its autotransplantation in patients with splenic trauma and patients with gastric cancer has a uniform character.

Approval of the Main Propositions of the Work

The materials of the research were presented at meetings of the Scientific Society of Surgeons of the Lipetsk Region (Lipetsk, 1997, 2000), at regional interregional scientific-practical conferences of Lipetsk (2003, 2004, 2005), at the Russian Scientific-Practical Conference "Thoracic Oncology" (Krasnodar, 2003), and at the International Scientific-Practical Conference "Medical-Biological and Ecological Problems of Human Health in the North" (Surgut, 2004).

15 publications have been issued, in which the main provisions of the dissertation are presented.

Structure and Volume of the Work

The dissertation consists of an introduction, a literature review, a chapter on materials and research methods, a general characterization of the studied patient group, four chapters of original observations, a conclusion, conclusions, practical recommendations, and a bibliography.