The optimal management of splenic marginal zone lymphoma (SMZL), a rare malignancy of the elderly, is not clearly defined. Splenectomy had been advocated in the past due to its palliative effect on abdominal discomfort, cytopenias, and prolonged remissions, even though most patients have disseminated disease in the bone marrow which subsequently relapses. No prospective studies compared outcomes after surgery or chemotherapy, so the choice of treatment is based on perception of individual benefits and risks. This study analyzed 1,251 cases of SMZL recorded in the Surveillance, Epidemiology, and End Results (SEER) database. Effects of splenectomy on survival outcomes were evaluated after balancing confounders with a propensity score (PS).While 52% of patients underwent spleen removal, no significant impact of the procedure on the risk of lymphoma-related death (LRD) (P 5 0.66)or overall survival was detectable. The results strengthen the notion that, with the availability of safe and effective alternatives, splenectomy should no longer be considered the treatment of choice in SMZL.