Splenectomy Does Not Increase COVID-19 Risk or Mortality in Abdominal Cancer Surgery: A Retrospective Cohort Analysis

Abstract

Objective: Splenectomy is frequently performed in abdominal malignancy surgeries due to direct tumor invasion, vascular injury, or for technical reasons. Although its association with bacterial infections is well documented, the effect of splenectomy on the risk and prognosis of viral infections, particularly COVID-19, remains unclear. To evaluate the incidence of postoperative COVID-19 infection and its prognostic impact in cancer patients undergoing abdominal surgery with and without splenectomy.

Methods: This retrospective, single-center study analyzed 337 patients who underwent abdominal surgery for malignancy between March 2020 and March 2022. Forty-four patients underwent splenectomy as part of their oncologic procedure. COVID-19 status, demographic characteristics, comorbidity burden (Charlson Comorbidity Index), and survival outcomes were compared between patients who underwent splenectomy and those who did not. Logistic regression and Kaplan–Meier survival analyses were performed.

Results: Postoperative COVID-19 infection occurred in 18.4% of all cancer patients and in 17.7% of those who underwent splenectomy. Splenectomy was not associated with a statistically significant increase in COVID-19 risk (odds ratio (OR): 1.58; 95% CI: 0.75-3.33; P = .22). This finding remained consistent after adjustment for comorbidities (OR: 1.50; 95% CI: 0.70-3.19; P = .29). Similarly, COVID-19 infection was not a significant predictor of mortality in the splenectomy group (adjusted OR: 1.02; 95% CI: 0.22-4.59; P = .97). Kaplan–Meier survival analysis revealed comparable overall survival between patients with and without splenectomy, with no statistically significant difference observed (log-rank test, P = .54).

Conclusion: Splenectomy in patients with abdominal malignancies was not found to be a risk factor for acquiring COVID-19 or for poor survival outcomes following infection. While this study suggests no detrimental effect of splenectomy on the clinical course of COVID-19 in patients with cancer, more comprehensive prospective investigations are necessary to support this conclusion.

Cite this article as: Deryol R, Avşar G, Hakseven M, Çulcu S, Utkan G, Ünal AE. Splenectomy does not increase COVID-19 risk or mortality in abdominal cancer surgery: A retrospective cohort analysis. Cerrahpaşa Med J. 2026, 50, 0076, doi:10.5152/ cjm.2026.25076.