Splenic metastases-not a frequent problem, but an underestimate location of metastases: epidemiology and course

Objective In the literature the frequency of splenic metastasis is documented very inconsistently. Only metastases of ovarial cancer are recommended for a surgical therapy. We examined the frequency of splenic metastasis in our hospital. Method The data of the Tumorboard Schwerin has been analyzed for splenic metastases. Based on hospital documents and contact via telephone the clinical course of the patients was also examined. Results A total of 6,137 of 29,364 patients with malignant tumors developed metastases (20.9%). We found 59 of these patients with splenic metastases (0.96%; 0.002% of all patients with malignant tumors). Men were more frequently concerned then women. The median age of the patients was 62 (26-88) years. There are only a few primary tumors metastasized in more than 1% into the spleen. A total of 47% of these metastases were synchronous, 53% metachronous. Only three patients had isolated splenic metastasis. Two further patients also had lymph node metastasis in the splenic hilus. Two other patients developed liver metastases after splenectomy. We performed four splenectomies because of splenic metastasis. The survival of splenic metastasis was median 3 (0-61) months. Discussion The published studies of the frequency of the splenic metastasis are autopsy studies, which are not usable for epidemiological statements because of selection bias. We show that splenic metastases arise in less than 1% of all metastases. A splenectomy in case of splenic metastases makes sense, if the metastases are isolated. It is also meaningful as a debulking procedure that would be followed by a chemotherapy, e. g. in case of an ovarial carcinoma. As a result the survival is increased for patients undergoing splenectomy (median survival 19.5 vs. 3 months).