Year 2021 Vol. 29 No 5

REVIEWS

K.F. CHERNOUSOV, R.V. KARPOVA, K.S. RUSSKOVA

SURGICAL OPTIONS FOR NONPARASITIC SPLENIC CYSTS

I.M. Sechenov First Moscow State Medical University, Moscow,
The Russian Federation

Nonparasitic splenic cysts (NPSCs) are uncommon lesions of the spleen, clinically, they may be asymptomatic. Their classification includes two basic groups: the true cysts or primary cysts and false or pseudo cysts based on the presence or absence of an epithelial lining. The need for surgery of nonparasitic cysts is due to the development of complications: suppuration, hemorrhage into the cavity of the cyst and its rupture. Historically, the conventional surgical method was splenectomy, however, complete removal of the organ, especially at a young age, often led to life-threatening infectious complications. Spleen-preserving surgery is considered to be an alternative to classical splenectomy: partial resection of the spleen and fenestration with excision of extra-hepatic cyst wall. However, as clinical practice has shown, these methods can be effectively used exclusively for the treatment of superficial cysts, and during the operation the ruptures of the capsule of the pathological focus with bleeding are observed. According to the general tendency in surgery to reduce the traumatization all patients were worked up with an ultrasound and X-Ray examination of the abdomen to look for the size and location of the splenic cysts. These operations include: drainage with sclerosing of the cyst and deepithelialization with superselective arterial embolization of the feeding vascular pedicle of the pathological focus. The study of these techniques revealed their weak points: the recurrence rate of cysts after sclerosis was 30-50%, and the use of embolizing agents in 50% of cases is complicated by ischemia of an organ segment with possible formation of an infarction zone in the early postoperative period. Nowadays the most promising method is considered to be a microwave ablation. Its thermal effect creates coagulation necrosis of the pathological focus and surrounding tissues with minimal toxic effects. This approach decidedly requires further research.

Keywords: splenic cyst, splenectomy, navigational surgery, percutaneous puncture, artery embolization, microwave ablation
p. 617-623 of the original issue
References
  1. Stepanova Yu.A., Alimurzaeva M.Z., Ionkin D.A. Ultrasonic differential diagnostics of cyst and cystic tumors of the spleen. Medical Visualization. 2020;24(3):63-75doi: 10.24835/1607-0763-2020-3-63-75. (In Russ.)
  2. Samarakoon LB, Si Min Goh S, Cheong YL, Ong LY. Massive splenic epidermoid cyst in a child treated with laparoscopic partial splenectomy case report and review of literature. Proc Singapore Healthc. 2019 Mar;28(1):61-64. doi: 10.1177/2010105818782523
  3. Chen YY, Shyr YM, Wang SE. Epidermoid cyst of the spleen. J Gastrointest Surg. 2013 Mar;17(3):555-61. doi: 10.1007/s11605-012-2088-y
  4. Andral G. Precis danatomie patliologique. Paris: Gabon; 1829. 432 p.
  5. Fowler RH. Nonparasitic benign cystic tumors of the spleen. Int Abstr Surg. 1953 Mar;96(3):209-27.
  6. Posta CG. Laparoscopic management of a splenic cyst. J Laparoendosc Surg. 1994 Oct;4(5):347-54. doi: 10.1089/lps.1994.4.347
  7. Hassoun J, Ortega G, Burkhalter LS, Josephs S, Qureshi FG. Management of nonparasitic splenic cysts in children. J Surg Res. 2018 Mar;223:142-48. doi: 10.1016/j.jss.2017.09.036
  8. Tuccari G, Giuffrè G, Muscarà M. Epidermoid cyst of the spleen: diagnosis suggested by fine-needle aspiration biopsy. Diagn Cytopathol. 1992;8(5):517-21. doi: 10.1002/dc.2840080512
  9. Shukla RM, Mukhopadhyay M, Mandal KC, Mukhopadhyay B. Giant congenital infected splenic cyst: An interesting case report and review of the literature. Indian J Surg. 2010 Jun;72(3):260-62. doi: 10.1007/s12262-010-0068-6
  10. Morgenstern L. Nonparasitic splenic cysts: pathogenesis, classification, and treatment. J Am Coll Surg. 2002 Mar;194(3):306-14. doi: 10.1016/s1072-7515(01)01178-4
  11. Schnorrer M, Fíger J, Labuda M. Splenectomy and sparing surgery of the spleen. Rozhl Chir. 1995 Mar;74(2):93-97. https://pubmed.ncbi.nlm.nih.gov/7761953/ [Article in Slovak]
  12. Schlittler LA, Dallagasperina VW. Non-parasitic splenic cysts. Rev Col Bras Cir. 2010 Dec;37(6):442-46. doi: 10.1590/s0100-69912010000600011 [Article in English, Portuguese]
  13. Kubyshkin VA, Ionkin DA. Opukholi i kisty selezenki, Moscow, RF: ID Medpraktika-M; 2007. 288 p. (In Russ.)
  14. Kenney CD, Hoeger YE, Yetasook AK, Linn JG, Denham EW, Carbray J, Ujiki MB. Management of non-parasitic splenic cysts: does size really matter? J Gastrointest Surg. 2014 Sep;18(9):1658-63. doi: 10.1007/s11605-014-2545-x
  15. Pointer Jr DT, Slakey DP. Cysts and tumors of the spleen. In: Yeo CJ, Gross SD, Jefferson T, eds. Cover for Shackelfords Surgery of the Alimentary Tract. 2-Vol Set. Elsevier Inc; 2019. p. 1654-59. doi: 10.1016/C2015-1-00854-7
  16. Selby C, Hart S, Ispahani P, Toghill PJ. Bacteraemia in adults after splenectomy or splenic irradiation. Q J Med. 1987 Jun;63(3):523-30. doi: 10.1093/oxfordjournals.qjmed.a068122
  17. Pate JW, Peters TG, Andrews CR. Postsplenectomy complications. Am Surg. 1985 Aug;51(8):437-41.
  18. Maslyakov VV, Barsukov VG, Shumanov AYu, Shihmagomedov AZ. Physiological justification of organ-preserving operations spleen injuries. Kazan Med Zhurn. 2011;92(3):335-40. https://cyberleninka.ru/article/n/fiziologicheskoe-obosnovanie-organosohranyayuschih-operatsiy-pri-travme-selezenki (In Russ.)
  19. Añon R, Guijarro J, Amoros C, Gil J, Bosca MM, Palmero J, Benages A. Congenital splenic cyst treated with percutaneous sclerosis using alcohol. Cardiovasc Intervent Radiol. 2006 Jul-Aug;29(4):691-93. doi: 10.1007/s00270-005-0144-7
  20. Poulin EC, Thibault C, DesCôteaux JG, Côté G. Partial laparoscopic splenectomy for trauma: technique and case report. Surg Laparosc Endosc. 1995 Aug;5(4):306-10.
  21. Manciu S, Tudor S, Vasilescu C. Splenic Cysts: A Strong indication for a minimally invasive partial splenectomy. could the splenic hilar vasculature type hold a defining role? world J Surg. 2018 Nov;42(11):3543-50. doi: 10.1007/s00268-018-4650-6
  22. Liu G, Fan Y. Feasibility and safety of laparoscopic partial splenectomy: a systematic review. World J Surg. 2019 Jun;43(6):1505-18. doi: 10.1007/s00268-019-04946-8
  23. Salky B, Zimmerman M, Bauer J, Gelernt I, Kreel I. Splenic cyst--definitive treatment by laparoscopy. Gastrointest Endosc. 1985 Jun;31(3):213-15. doi: 10.1016/s0016-5107(85)72049-4
  24. Milosavljević V, Tadić B, Grubor N, Erić D, Matić S. Laparoscopic technique as a method of choice in the treatment of non-parasitic splenic cysts. Srpski Arhiv za Celokupno Lekarstvo. 2019 Mar;147(5):307-10. doi: 10.2298/SARH181008029M
  25. Krasilnikov DM, Tolstikov AP. Surgical treatment of patients with non-parasitic hepatic cysts. Kreativ Khirurgiia i Onkologiia. 2012;25(5):481-87. doi: 10.24060/2076-3093-2012-0-1-91-97 (In Russ.)
  26. Karfis EA, Roustanis E, Tsimoyiannis EC. Surgical management of nonparasitic splenic cysts. JSLS. 2009 Apr-Jun;13(2):207-12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015942/
  27. Kawamura J, Hiura M, Ueda M, Higashi Y, Yoshida O, Kuwahara C, Ueda M. Ultrasound-guided renal cyst puncture and 95% ethanol injection. Part 1: Estimation of ethanol levels in the blood and urine following 95% ethanol injection. Hinyokika Kiyo. 1984 Mar;30(3):287-94. https://repository.kulib.kyoto-u.ac.jp/dspace/bitstream/2433/118145/1/30_287.pdf
  28. Shiryaev AA, Musaev GH, Harnas SS, Ryabova AV, Kondrashin SA, Loshchenov VB, Volkova AI, Pominova DV, Akhmedova SM, Zhemerikin GA. Non-parasitic splenic cysts. Methods of surgical treatment. Vestn Khirurg Gastroenterologii. 2013;(4):26-32. https://www.elibrary.ru/item.asp?id=25672130 (In Russ.)
  29. Akhan O, Dagoglu-Kartal MG, Ciftci T, Ozer C, Erbahceci A, Akinci D. Percutaneous treatment of non-parasitic splenic cysts: Long-term results for single- versus multiple-session treatment. Cardiovasc Intervent Radiol. 2017 Sep;40(9):1421-30. doi: 10.1007/s00270-017-1650-0
  30. Belyaeva AV, Polyaev AYu, Rosinov V. Nonparasitic splenic cysts in children (etiology, classification, organ preservation therapy) Ros Vestn Det Khirurgii, Anesteziologii i Reanimatologii. 2016;6(3):102-8. https://rpsjournal.ru/jour/article/view/278/279/ru_RU (In Russ.)
  31. Cairang Y, Zhang L, Ren B, Ren L, Hou L, Wang H, Zhou Y, Zhang Q, Shao J, Fan H. Efficacy and safety of ultrasound-guided percutaneous microwave ablation for the treatment of hepatic alveolar echinococcosis: A preliminary study. Medicine (Baltimore). 2017 Jul;96(27):e7137. doi: 10.1097/MD.0000000000007137
  32. Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT Jr, Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why? Radiographics. 2014 Sep-Oct;34(5):1344-62. doi: 10.1148/rg.345140054
  33. Karpova R, Mishin A, Guseinov S. Microwave ablation of splenic cyst: A case report. Ann Med Surg (Lond). 2019 Apr 12;41:40-42. doi: 10.1016/j.amsu.2019.03.014. eCollection 2019 May.
  34. Luo N, Wang Y, Geng Z, Qin X. Analysis of feasibility, safety and effectiveness of ultrasound-guided percutaneous microwave ablation of splenic neoplasm. Oncol Lett. 2018 Oct;16(4):4807-12. doi: 10.3892/ol.2018.7845
Address for correspondence:
119435, Russian Federation,
Moscow, Bolshaya Pirogovskaya str., 6-1,
I.M. Sechenov First Moscow State Medical University,
the Department of Faculty Surgery No1,
tel. +7 916 478-37-65,
e-mail: kirill_chernousov@bk.ru,
Chernousov Kirill F.
Information about the authors:
Karpova Radmila V., MD, Professor of the Department of Faculty Surgery No1, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-0608-9846
Chernousov Kirill F., Post-Graduate Student, the Department of Faculty Surgery No1, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-1751-4601
Russkova Ksenia S., a 6th-Year Student, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-2150-7567
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