Skip to navigation Skip to main content

Myelodysplastic Syndromes (MDS)

PAGE CONTENTS

Surgery

Myelodysplastic syndromes (MDS) are a group of rare hematological disorders in which conditions that interfere with the growth of blood cells most often result in the underproduction of normal blood cells in the bone marrow. Affected clonal hematopoietic stem cells do not mature into healthy red or white blood cells or platelets.1 

Surgeries for MDS Diagnosis

For a diagnosis of MDS, patients undergo a bone marrow biopsy to detect the presence of abnormal blood cells in a sample of bone marrow fluid. A needle may be inserted into the pelvic bone or sternum to obtain bone marrow fluid.1

Read more about MDS diagnosis

Surgeries for MDS Treatment

Surgery is not a primary treatment for MDS because it cannot remove all abnormal, immature blood cells from the body. Typically, in hematological disorders such as MDS, the only potentially curative treatment is stem cell transplantation or a bone marrow transplant.1 

Central Venous Infusaport Placement

In some cases, a central venous infusaport may be surgically implanted under the skin, usually beneath the clavicle. Such a port may be useful if a patient with MDS frequently requires blood transfusions or treatment with antibiotics for bacterial infections. Physicians can also collect blood samples through the infusaport to reduce the number of needle punctures required for blood testing.1 

Read more about MDS therapies

Splenectomy

Splenectomy, or surgical removal of the spleen, is very rarely used to treat patients with MDS who have immune-related thrombocytopenia.2 With currently available treatments, however, splenectomy is usually not indicated for patients with MDS, as it may lead to unnecessary complications.3

In the past, some cancer centers included splenectomy as a part of their treatment algorithm for hypoplastic subtypes of MDS (bone marrow blast counts <10%) refractory to treatment with transfusions or initial treatment with Gengraf® or Neoral® (cyclosporine).2

A study published in 2010 described the results of splenectomy in 43 people with hypoplastic MDS refractory to treatment. Following splenectomy, cytopenias were improved in nearly half (48%) of the patients, the need for transfusions was decreased in 42%, and transfusion independence was achieved in 6%. Complications of splenectomy included hemorrhage in 1 patient. In this study, no deaths occurred that were directly related to splenectomy.2

Currently, splenectomy is rarely used for the management of MDS. However, researchers speculate that splenectomy, which removes the “cell-destroying” organ, in some cases may increase blood cell production by deleting large lymphoid compartments that alter immune pathways and contribute to the development of cytopenias in MDS. In addition, patients with MDS who undergo splenectomy may become more sensitive to immunosuppressive agents, thereby increasing the efficacy of formerly ineffective treatments following surgery.2

Read more about MDS treatment

Surgical Outcomes in Patients with MDS

A study published in 2012 analyzed the surgical outcomes of people with MDS. Of 169 patients with MDS, 39 (23%) underwent surgical procedures under general anesthesia for various unrelated conditions.4 

The postoperative mortality rates in the patients with MDS who underwent surgery under general anesthesia were high; 23% of the patients died within 30 days, and 30.8% died within 60 days after the surgery. Approximately 59% had required emergency surgery, and postoperative mortality rates after 60 days were higher in these patients than in those who underwent elective procedures.4

Generally, patients with MDS had poor 2-year survival rates after emergency surgery under general anesthesia.4  

Read more about MDS prognosis

Surgical Prophylaxis in MDS

Patients with MDS and accompanying thrombocytopenia who choose to undergo elective surgery can prepare in advance for the operation. Platelet transfusions just before surgery may reduce the risk of bleeding.5,6 

The American Society of Clinical Oncology (ASCO) and Infectious Diseases Society of America (IDSA) also recommend antibiotic prophylaxis in immunocompromised cancer patients. This is because immunosuppressed or immunocompromised patients with profound, prolonged neutropenia are predisposed to frequent infection.7 Antibiotic prophylaxis is frequently administered immediately before surgical and dental procedures to decrease the risk of bacterial infection.8,9  

Read more about MDS risk factors

References

  1. Surgery for MDS. Moffitt Cancer Center. Accessed June 8, 2023.
  2. Kokhno AV, Mikhailova EA, Parovichnikova EN, et al. Splenectomy in patients with MDS. Blood. 2010;116(21):1879. doi:10.1182/blood.V116.21.1879.1879
  3. Besa EC. Myelodysplastic syndrome (MDS) treatment & management. Surgical care. Medscape. Updated October 1, 2022. Accessed June 8, 2023.
  4. McNally ME, Malhotra L, Bloomston M, Schmidt CR. Perioperative mortality in patients with myelodysplastic syndrome. J Surg Oncol. 2012;106(1):46-50. doi:10.1002/jso.23032
  5. Kurtin S. Building blocks of hope: strategies for patients & caregivers living with MDS. MDS Foundation. Accessed June 8, 2023. 
  6. Estcourt LJ, Malouf R, Doree C, Trivella M, Hopewell S, Birchall J. Prophylactic platelet transfusions prior to surgery for people with a low platelet count. Cochrane Database Syst Rev. 2017;2017(9):CD012779. doi:10.1002/14651858.CD012779
  7. Taplitz RA, Kennedy EB, Bow EJ, et al. Antimicrobial prophylaxis for adult patients with cancer-related immunosuppression: ASCO and IDSA clinical practice guideline update. J Clin Oncol. 2018;36(30):3043-3054. doi:10.1200/JCO.18.00374
  8. Crader MF, Varacallo M. Preoperative antibiotic prophylaxis. StatPearls [Internet]. Updated May 29, 2023. Accessed June 8, 2023.
  9. Antibiotic prophylaxis prior to dental procedures. ADA. Accessed June 8, 2023.

Reviewed by Hasan Avcu, on 6/12/2023.

  • Loading...

    Continuing Medical Education (CME/CE) Courses

    Show More

READ MORE ON MDS