Surgery is not a common treatment for chronic leukaemia. But some people with chronic lymphocytic leukaemia (CLL) need an operation to remove the spleen (splenectomy).
The spleen is an organ on the upper left side of your tummy (abdomen).
It is part of the lymphatic system and filters the blood, removing worn out red blood cells. It also stores red blood cells and contains lymph node tissue and many lymphocytes. Lymphocytes are types of white blood cells. Your white blood cells help fight infection.
Why you might have your spleen removed
The spleen is quite a large organ. In chronic leukaemia, it sometimes becomes bigger and can cause problems.
The spleen's normal job is to filter the blood and to destroy and break down worn out red blood cells. When you have CLL your spleen can become so clogged up with abnormal cells that it doesn't work properly. The spleen swells because there are too many blood vessels.
An operation to remove the spleen is called a splenectomy. You might have this 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
Your enlarged spleen might destroy too many red blood cells and platelets. This can make you tired and breathless. Or you might find you are bleeding more than usual.
Removing the spleen can relieve these symptoms. In chronic lymphocytic leukaemia, this operation might relieve the low red blood cells and low platelets for up to 3 years.
Your specialist might suggest a short course of radiotherapy to the spleen, if you can't have surgery for any reason.
Your surgeon might remove your spleen through either:
- a large cut just under your ribs in the middle or left side of your abdomen (open surgery)
- keyhole (laparoscopic) surgery
Keyhole surgery is where the surgeon makes a few small cuts in your abdomen. They put a thin tube called a laparoscope through one of the cuts. The tube has a camera attached. The surgeon can see the pictures of the inside of your abdomen on a TV screen.
Through the other cuts they put in surgical instruments to remove the spleen.
You usually recover more quickly from keyhole surgery than open surgery, and you can go home sooner. But it may not be possible for you to have keyhole surgery if your spleen is too large.
Helping protect your immune system
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
You will need to take antibiotics for the rest of your life because of these changes to your immune system.