Partial Splenectomy Versus Total Splenectomy in Sickle Cell Disease: A Systematic Review and Meta-Analysis.

Background: Sickle cell disease (SCD) patients encounter various complications, such as acute splenic sequestration crisis and hypersplenism that may require splenectomy. This systematic review and meta-analysis aims to clarify differences between total splenectomy (TS) or partial splenectomy (PS) in terms of hematological and postoperative outcomes.

Methods: We identified studies involving SCD patients who underwent PS or TS, whether open or laparoscopic, and whose hematological and operative outcomes were evaluated, through searching PubMed, Web of Science, Scopus, Embase and Cochrane databases from inception until June 2024.

Primary Outcomes: hemoglobin concentration and reticulocytes %.

Secondary Outcomes: operative blood transfusion need, length of hospital stay (LoS), postoperative infections, overwhelming postsplenectomy sepsis (OPSS), acute chest syndrome (ACS), thromboembolic events and mortality.

Results: Eighteen studies were included; 17 cohort and one case series. Seven studies collected data from the same SICHA institutions, so a total of 756 SCD patients is included. According to the most recent study, no significant changes in hemoglobin (preoperative 10.5 ± 0.3 vs 9.6 ± 0.4 one year postoperative in 24 PS cases, and 9.7 ± 0.1 vs 9.7 ± 0.2 in 73 TS cases), however, both TS and PS significantly decreased reticulocyte by 2 % (0.8-3.2 %). Proportional analysis of short-term infection revealed a lower incidence in TS 2.71 % vs 8.64 % in PS, and similarly for ACS, it is 6.97 % in TS vs 14.90 % in PS.

Conclusion: This first systematic review and meta-analysis shows that TS and PS have no or minimal effect on hemoglobin but a strong lowering effect on reticulocyte %. Proportional analysis reveals lower short-term infections and ACS following TS than PS. However, further clinical trials are necessary to draw definite conclusions and improve surgical decision making.

Type Of Study: Systematic review and meta-analysis of cohort studies.

Level Of Evidence: II.