To the Editor—In a case-matched study of patients undergoing surgery for colorectal cancer with or without incidental splenectomy to control bleeding from iatrogenic trauma by Dr. Wakeman and colleagues,
1 the authors concluded that incidental splenectomy as a result of iatrogenic trauma adversely affects long-term survival in patients who have colorectal resection for colorectal carcinoma. All operations were performed in five major New Zealand teaching hospitals, and age, sex, American Society of Anesthesiologists, disease stage, and operation type were matched for comparison between patients with splenectomy and without splenectomy. In the
Methods section, it is mentioned that in addition to univariate analysis, multivariate survival analyses were performed by using a Cox proportional hazard model, which revealed that patients with splenectomy had a higher risk for death (hazard ratio, 1.8; 95 percent confidence interval (CI), 1–3.3) after a median follow-up period of 43 months. The reason why incidental splenectomy for intraoperative splenic injury led to adverse long-term outcomes after colorectal cancer surgery is not discussed in detail. …
