Long-term Follow-up of Laparoscopic Splenectomy in Patients with Immune Thrombocytopenic Purpura

Abstract

Laparoscopic splenectomy (LS) has been reserved for intractable and relapsing immune thrombocytopenic purpura (ITP) despite medical treatment. With further experiences of LS in ITP, we investigated long term outcomes of LS, especially newly developed morbidities, and tried to find predictive factors for favorable outcomes. From August 1994 to December 2004, fifty-nine patients whose follow-up period was more than 12 months after LS were investigated. After a long-term follow-up (median 54 months, range 12.5-129 months), a complete response (CR) was found in 28 patients (47.5%), partial response in 24 (40.7%), and no response in 7 (11.9%). The relapse rate during follow-up periods was 15.2%. The rapid response group (p=0.017), in which the platelet count increased more than twice of the preoperative platelet count within 7 days after LS, relapsing after medical treatment (p=0.02), and the satisfactory group as the initial result of LS (p=0.001) were significant for predicting CR in univariate analysis, but only the initial satisfactory group was an independent predictive factor for CR in multivariate analysis (p=0.036, relative risk=6419; 95% CI, 1.171-35.190). Infections were the most frequent morbidities during the follow-up period, which were treated well without mortality. LS is a safe and effective treatment modality for ITP. Active referral to surgery might be required, considering complications and treatment results related to long-term use of steroid-based medications.

Long-term Relapse-free Rurvival Rate and Predictive Factors of Idiopathic Thrombocytopenic Purpura in Adults Undergoing Splenectomy

“…But the overall complication rate is low in LS. [24,30] As our study, Tsereteli et al, [31] did not find any significant difference between the open and laparoscopic procedures as a predictive factor of favorable outcome.…”

Rituximab in the treatment of autoimmune haematological disorders

“…For those who fail to respond to these treatments or who require continued treatment, a splenectomy may be considered (Cines & Bussel, 2005;Nakhoul et al, 2006). Although splenectomy is an effective treatment for many patients, with approximately three-quarters achieving a durable response (Kumar et al, 2002;Kang et al, 2007), it carries with it an increased risk of infection (Kang et al, 2007) and a risk of death from postsplenectomy sepsis of up to 1% (Kumar et al, 2002).…”

Long-term Clinical Results of Laparoscopic Splenectomy for Surgical Disease of the Spleen: Recent Outcomes

“…First, it had a longer follow-up period (mean, 84 months) than previous studies: one had a mean of 43.6 months and a range of 9∼114 months 7 ; another had a mean of 20±14 months; 19 and a third had a mean of 54 months and range of 12.5∼129 months. 18 Second, this study demonstrated lower morbidity and mortality rates. In this study, regardless of diagnosis, the overall morbidity rate was 5.8%.…”

“…Other studies reported an 80.3% long-term response rate of the 127 patients, 7 an 85% rate of remission in the total of 147 patients, 19 and an 88.2% response rate and 15.2% relapse rate during the follow-up period in 59 patients (Table 6). 18 Also, in this study, a single relapsed patient was treated with re-operation by laparoscopic method, so this result must be excellent outcome. Furthermore, compared to previous studies, this study had some strengths.…”

“…16 A recent review of 402 cases of splenectomy for ITP between 1959 and 2002 reported that 1.5% of all patients developed perioperative infections (most commonly pneumonia). Further, 8% of patients (one-third of whom had been 17 In the study of Kang et al, 18 infections were the most frequent morbidities during the follow-up period. However, in the current study, neither postoperative deaths nor subsequent fatal infections were observed, despite the fact that only five of 28 patients with ITP were vaccinated.…”