Surgical Spleen Pt. 3: Splenectomy Aftercare and Prognosis

Splenic lesions make up 0.3 to 2% of all neoplasia in dogs over 8 years of age and 5% of all non-skin primary malignant neoplasms in large breed dogs. Splenic masses are neoplastic in 48.2 to 66% of cases, unclassified in 0.4%, and not neoplastic in 34% to 54.1%. Overall malignant incidence 76.1% and benign 23.9%.

Canine splenic neoplasia has a 33 to 66% incidence overall. Of splenic lesions, 80% are malignant and 10% are benign (hematoma or hemangioma). Of the malignant splenic/hepatic neoplasms, 50 to 90% are hemangiosarcoma, making it the most prevalent.

Overall, hemangiosarcoma is found in 65 to 88% of affected dogs. Splenic hemangiosarcoma cases in dogs present with hemoperitoneum in 76.1% of cases and hematoma in 29.6% of cases. Of dogs with hemangiosarcoma, in 75% of such cases the hemangiosarcoma lesion is the source of the hemorrhage with hemoabdomen cases.

Other canine splenic neoplastic malignancies include chondrosarcoma, fibrosarcoma, leiomyosarcoma, leiomyoma, lipoma, liposarcoma, malignant fibrous histiocytoma, metastatic adenocarcinoma, mast cell tumor, myeloproliferative disease, myxosarcoma, osteosarcoma, rhabdomyosarcoma, poorly differentiated/undifferentiated sarcoma, sarcoma, malignant splenic carcinoma, mesothelioma, melanoma, lymphosarcoma, pheochromocytoma, and adrenocortical carcinoma. Overall these are seen in 22 to 43% of cases.

Hemangiosarcoma is a malignancy of vascular endothelial origin that results in widespread metastatic disease and poor survival in dogs.

Common primary sites of hemangiosarcoma include the spleen, right atrium and skin. Other locations include the liver, pericardium, peritoneum, vertebrae, eyes, kidneys, oral cavity, mucous membranes, bones, urinary bladder, tongue, and prostate.

The World Health Organization (WHO) describes the status of the tumor, regional lymph node, and distant metastatic disease and is used to dictate prognosis. Stage I disease defines localized disease with only the primary tumor, stage II designates only the primary tumor with lymph node involvement or ruptured splenic hemangiosarcoma, and stage III are cases with metastatic disease present with splenic rupture or lymph node involvement.

Most often, dogs affected with localized or generalized splenic disease are 5 to 11 years of age. The mean age of dogs is 10 years with a range of 3 to 15 years.

There is an increased risk of hemangiosarcoma seen with the Golden Retriever (20% incidence), German Shepherd dog (12.5 to 31.5% incidence), Labrador Retriever (10.5 to 20% incidence), Boxer (7.8% incidence), Rhodesian Ridgeback (12.5% incidence, also a breed at risk for splenic hematoma), Schnauzer, and Standard Poodle, although any breed may be affected. Males are predisposed.

After as thorough of a diagnostic evaluation as is possible and appropriate, the ideal treatment is a complete splenectomy with evaluation for metastatic disease at the time of surgery.

Stage I to II dogs that survive 7 days post-operatively are alive by 86 days with a range of 14 to 470 days and 6% are alive at 1 year. The prognosis for stage I dogs is better than those with stage II and stage III disease.

Canine hemoperitoneum cases in general have a hospitalization duration of two days with a 85% survival rate. Benign splenic growths result in 85% of these dogs being discharged from the hospital.

The survival time for canine splenectomy with benign and malignant disease is 338 to 650 days and 85 days, respectively. The 8 week, 36 week, 1 year, 3 year, and 6 year survival times with benign disease post-splenectomy is 85%, 75%, 64 to 85%, 45%, and 30%, respectively. The 1 year, 3 year, and 6 year survival times with malignant disease post-splenectomy is 20%, 10%, and 7%, respectively. These differences are significant.

Post-operative hemangiosarcoma mean survival time is 19 days, with 31% of dogs alive at 2 months, 7% alive at one year with stage I being 151 days, stage II 107 days, and stage III 73 days (range 68 to 136 days). Hemangiosarcoma stage I to II was 50 to 75% with 86 day survival, significant 1 year survival 6%. Cases with a single mass, 16% are alive at 1 year.

With hemangiosarcoma, the post-operative survival by 2 months is 30% versus an 85% survival with non-neoplastic hematoma. The hemangiosarcoma one year survival is 7% versus 65% with hematoma. Survival duration for hemangiosarcoma ranges from 19 to 65 days with surgery alone. The median survival post-operatively is 86 days and less than 10% survived for one year, while survival duration is 172 days with doxorubicin-based chemotherapy.

If cancer is present 75% are HSA with a preoperative mortality of 40 to 60%. Canine hemoperitoneum in general results in death or euthanasia in 15% of cases.

[glamdolly]

What is the expected survival time for a dog that has spleen removed that was benign, ie non cancerous? My Maltese bitch was 13 in November - this week I took her to the vet because she was off her food and he felt a mass on her spleen, confirmed by a scan.
He said chances of her surviving surgery at her age were 50-50 and that if she has cancer she would not have long to live anyway, even with surgery. He also said the only way to find out if it is cancer is to open her up.
Please can you tell me what you would advise your patient? She has always been in good health until now and I expected her to go on happily for another few years. I love her dearly and if I can save her I will - but I don't want to put her through the ordeal of surgery if she is not likely to survive, or won't survive for long.
Also - I am worried she may be in pain at the end, as the vet told me she could get a ruptured spleen with internal bleeding that may be sudden and have her fighting for breath and distressed. He said if that happened she would need a transfusion, emergency surgery to remove the spleen - or of course, the other option is euthanasia. But I am currently looking into surgery with a specialist vet hospital and if they are more confident than my vet about her chances, I will get it done urgently.
If you can offer me any advice or insights at this worrying time, I would be so very grateful. Lisa. X