In patients undergoing cytoreductive surgery together with hyperthermic intraperitoneal chemotherapy, only one previous study which we are aware of assessed the relationship between splenectomy and postoperative neutropenia; no association was found (25). Therefore, we chose to examine the effect of splenectomy on hematologic toxicity after hyperthermic intraperitoneal chemotherapy with cytoreductive surgery, and assess the

use of granulocyte colony stimulating factor. In the patients who underwent Inhibitors,research,lifescience,medical splenectomy, the white cell nadir was higher, and therefore, splenectomy ameliorated the neutropenia attendant to hyperthermic intraperitoneal chemotherapy. This resulted in a significant decrease in the need for recombinant granulocyte colony stimulating factor support using a standard protocol Inhibitors,research,lifescience,medical for its utilization. The platelet nadir was also higher in the splenectomy group, though this did not result in a significant difference in platelet utilization. Since patients who underwent splenectomy in this experience had disease seen grossly on the organs, splenectomy also correlates

Inhibitors,research,lifescience,medical with increased tumor burden. Consequently, it is not surprising that a significantly higher grade hemoglobin toxicity was seen in the splenectomy cohort as they required a more extensive operative intervention. This is consistent with the lower hemoglobin nadir in the splenectomy group, and translated into significantly more red blood cell transfusions in this population. Furthermore, given the increased peritoneal dissemination in splenectomy patients compared to non-splenectomy patients, Inhibitors,research,lifescience,medical and thus the need for more extensive multivisceral resection, it is also not surprising that the splenectomy cohort had, on average, a significantly longer hospital stay. Additionally, while a higher proportion of splenectomy patients Inhibitors,research,lifescience,medical expired, there was not a statistically significant difference

in the mortality between the two groups or in the proportion of patients who expired from cytopenia. Splenectomy is associated with morbidities including MTMR9 atelectasis, pleural effusion, pancreatic injury, thrombocytosis, subphrenic abscess, and pancreatic pseudocyst formation (26). A feared complication after splenectomy is overwhelming sepsis, which has an overall mortality of 50%, and may occur between 24 days to 65 days after surgery (27). Pneumococcus is the causative organism in over 60% of cases. Our current standard of care involves vaccination with polyvalent Erlotinib in vivo pneumococcal vaccine, H. influenzae type b conjugate, and meningococcal polysaccharide vaccine within 2 weeks of splenectomy (28). We routinely administer, and suggest vaccinations for patients undergoing splenectomy. When splenectomy can be anticipated based upon imaging, preoperative vaccination is preferred.