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Surgery

Surgery does not play a major role in the management of leukemia. The reasons for this are two-fold: (1) leukemia cells usually are widespread throughout the body at the time of diagnosis, so they cannot be "cut out" like other forms of cancer; and (2) surgery is not needed for diagnosis, since bone marrow aspiration usually is adequate to confirm the disease.

Aside from the insertion of a venous access device (a plastic tube that is surgically implanted into a large vein in the chest or upper arm) to reduce the need for repeated needle sticks during drug injections or removal of blood samples, splenectomy (removal of the spleen) may be the only surgical procedure performed during the treatment of leukemia.

The spleen normally helps to filter out old and damaged blood cells from the circulation. If leukemia causes substantial spleen enlargement of more than 4 centimeters (> 4 cm), it may press upon other organs and cause abdominal symptoms. In addition, an overgrown spleen may become too effective in removing blood cells and cause a shortage of red blood cells or platelets. Therefore, surgical removal of the spleen is a form of therapy that may improve symptoms and blood profiles in some leukemia patients, such as individuals with chronic lymphocytic leukemia (CLL) or hairy cell leukemia. The primary danger of splenectomy, especially in people with compromised immune systems, is infection in the blood or tissues (sepsis). Microorganisms commonly involved in such sepsis include pneumococci, meningococci, E. coli, Haemophilus influenzae, and staphylococci.

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