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Surgery for chronic lymphocytic leukaemia (CLL)

Men and women discussing chronic lymphocytic leukaemia

This page is about surgery for chronic lymphocytic leukaemia (CLL). There is information about

 

A quick guide to what's on this page

Surgery for chronic lymphocytic leukaemia (CLL)

Surgery is not often used to treat CLL. This is because leukaemia is a systemic disease that affects the whole body. So the best treatment is one that treats the whole body, such as chemotherapy or biological therapy. But some people may need to have a minor operation to remove a lymph node for examination under the microscope (lymph node biopsy).

Some people may have an operation to remove the spleen. This is called a splenectomy. Your doctor may suggest you have a splenectomy because your spleen

  • Is so large it is making you uncomfortable or causing you pain
  • Is destroying too many red blood cells or platelets
  • Has not shrunk after chemotherapy

The surgeon may remove the spleen through a cut made just under the ribs on the left hand side. Or they may use keyhole surgery.

Without a spleen you will be more at risk of infection. To help prevent infection in the future, you will need to have some vaccinations before, or just after, the operation. It is best to have these 2 weeks before having your spleen removed. And you will need to take antibiotics for the rest of your life. In case of a medical emergency you should carry a card saying your spleen has been removed.

 

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Surgery in CLL

Doctors don't often use surgery to treat chronic leukaemia. Leukaemia is a disease that affects the whole body. This is called a systemic disease. So the best treatment is one that treats the whole body, such as chemotherapy or biological therapy. But some people need to have a lymph node biopsy or an operation to remove the spleen (splenectomy). 

 

Lymph node biopsy

It isn't very common to remove a lymph node in CLL. It isn't usually necessary because your doctor gets the diagnosis from blood and bone marrow tests. But sometimes the leukaemia cells can get into the lymph nodes and start growing there. This can be a sign that the disease is changing (transforming) into a type of lymphoma called Richter's syndrome. If your doctor thinks this may be happening, they may ask to remove one of your lymph nodes. The surgeon will send the lymph node to the lab where a pathologist will look at it closely under a microscope.

A lymph node biopsy is usually a minor operation. You may have a local or a general anaesthetic depending on where the lymph node is in the body. Depending on the time of your surgery, you can often go home the same day. Afterwards you will have a few stitches where the surgeon removed the lymph node. The wound will be covered with a dressing. The area is likely to be a bit sore and stiff. Your doctor or nurse will give you some painkillers to take for a few days until the pain wears off. You will have your stitches removed after about 7 to 10 days.

 

Removing the spleen (splenectomy)

The spleen is quite a large organ. In chronic leukaemia, it sometimes becomes bigger and can cause problems.

Diagram showing the position of the spleen

An operation to remove the spleen is called a splenectomy. Your doctor may suggest you have a splenectomy for the following reasons.

  • Your spleen is so large it is making you uncomfortable or causing you pain
  • Your spleen is destroying too many red blood cells or platelets
  • Your spleen has not shrunk after chemotherapy

In chronic leukaemia the spleen can become so clogged up with abnormal cells that it doesn't work properly. The spleen swells because it has a lot of blood vessels. Its normal job is to filter the blood, and destroy and break down worn out red blood cells. The enlarged spleen may destroy too many red blood cells and platelets. A very low red blood cell count is called anaemia. Anaemia makes you tired and breathless. If you have low numbers of platelets you may bleed more than usual. This is because the platelets are essential for normal blood clotting.

Removing the spleen may give you lasting relief from these symptoms. In chronic lymphocytic leukaemia, this operation may relieve anaemia and low platelets for up to 3 years. If you can't have surgery for any reason, your specialist may suggest a short course of radiotherapy to the spleen. 

Your operation

The surgeon may remove your spleen through a cut made just under the ribs on the left hand side. Or they may use keyhole surgery. Keyhole surgery is where the surgeon makes a few very small cuts and puts a thin tube called a laparoscope through one of the holes. Through the other holes they put surgical instruments to remove the spleen. With laparoscopic surgery, you usually recover more quickly and are able to go home sooner. But it may not be possible for you to have keyhole surgery if your spleen is too bulky to get through the very small cuts.

A few people will come and see you before your operation. Your surgeon will explain what will happen during the operation and will ask you to sign a consent form agreeing to surgery. A physiotherapist will come and explain breathing and leg exercises to you. You will need to do these to help you recover and help prevent you getting a chest infection or blood clots (deep vein thrombosis or DVT).

The spleen is part of your immune system and helps to fight infection. Without a spleen you will be more at risk of infection. To help prevent infection in the future, you will need to have some vaccinations before, or just after, the operation. It is best to have these 2 weeks before having your spleen removed. And you will need to take antibiotics for the rest of your life.

In case of a medical emergency you should carry a card saying your spleen has been removed. Before you go abroad, talk to your doctor. They may advise extra vaccinations because your immunity is reduced if you have no spleen.

Recovering from your operation

If you have a splenectomy, you will probably have a few tubes in place when you wake up. These are

Your nurse will take your drip out as soon as you can start eating and drinking again. This may take a couple of days. Your doctor will listen to your stomach (abdomen) with a stethoscope. As soon as the doctor can hear your bowel working again, you will be able to start taking sips of water. Gradually you will work up to eating and drinking normally.

The drainage tubes connect to containers that collect the fluid draining from the wound. Once there is no more fluid draining, your nurse will take them out. This is normally after a couple of days. It only takes a minute to gently pull the tubes out and you may have some discomfort during that time.

The nurses will help you to get up and move around gently as soon as possible. This helps you to get better and reduces the risk of complications such as chest infections or blood clots.

You can usually go home a week or so after this type of surgery. If you have had laparoscopic surgery you will be able to go home sooner – perhaps after a couple of days. Your stitches will need to be taken out about two weeks after your operation. You may go back to the hospital to have this done, or go to your GP surgery.

Before you leave the hospital, your nurse will give you an appointment to go back and see your surgeon. This is usually about 6 weeks later. It is usually advised after stomach (abdominal) surgery not to go back to work or start driving again until you've been given the all clear at your follow up appointment.

We now know that exercise is good for you when you are recovering from surgery. But it is best not to overdo it. Start with walking slowly for short distances – remember to be aware of the distance you'll have to walk back. Gradually build up the amount you walk over days and weeks. It can help you to feel better and recover more quickly.

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Updated: 10 March 2015