Predictive Factors for Success of Laparoscopic Splenectomy for ITP

Abstract

Background and Objectives:Therapy-resistant immune thrombocytopenia (ITP) is the most frequent indication of laparoscopic splenectomy (LS). It ensures the best results for this disease compared with possible second-line pharmacologic therapies. Therefore, learning about the safety of the surgical method and its long-term efficacy is important, as is selecting patients who respond to surgical treatment. Our purpose was to analyze the safety of LS and the short-and long-term prognostic significance of known perioperative parameters.Methods:We performed 40 LSs for ITP from January 1, 2000, to January 1, 2015. We analyzed the roles of the perioperative parameters by using evidence-based guidelines.Results:Complete response (CR; platelet count over 100 × 109/L) occurred in 28 cases (70%) and partial response (PR; platelet count between 30 and 100 × 109/L) in 5 cases (12.5%). Below the age of 50, 9% (2/22) of the patients had no response (NR; platelet count not increasing over 30 × 109/L), 28% (5/18) over the age of 50 (P = .023) had no response. In the steroid-refractory group, 30% did not respond, whereas 100% of the steroid-dependent patients had a CR (NR: 7/23 steroid refractory vs 0/17 steroid dependent; P = .027). The patients were followed up for a mean of 10.9 ± 6.9 years, and a long-term response (LTR) was detected in 21 of the responders (n = 33). Of the patients who originally had a CR, 71% also achieved LTR, whereas only 20% of the PR patients did.Conclusion:LS is safe and remains the most effective second-line treatment for ITP. In our study, younger age and response to preoperative steroids were predictive factors for the long-term success of splenectomy.

Splenomegaly and Response to Splenectomy in Immune Thrombocytopenia

“…The prognostic significance of age has been previously reported and is validated in our cohort [20,39]. Other variables, consisting of spleen size and prior lines of therapy, have not been well characterized previously.…”

“…Meta-analyses have demonstrated a 60-70% complete response rate to splenectomy [19]. Though no clear preoperative characteristics that predict splenectomy response have previously been identified, there are some data demonstrating better outcomes in patients <50 years of age and those responsive to first-line medical therapy [20]. Others have shown no statistically significant association between age, gender, body mass index, ASA classification, disease duration, accessory spleens, splenic weight, conversion to open surgery, or perioperative complications with post-splenectomy response rates [21].…”

A laparoscopic approach to address massive splenomegaly, symptomatic cholelithiasis, and a planned postoperative pregnancy: A case report

“…Navez and Zheng 26,27 had limited success predicting favorable outcomes using demographic and laboratory data. Istl and Nyilas 28,29 were able to predict favorable surgical outcomes based on corticosteroid therapy responses. Splenectomy for patients with thrombocytopenia can often be avoided as patient outcomes associated with medical therapy continue to improve.…”

Laparoszkópos lépsebészet a szegedi Sebészeti Klinikán

“…A III. vizsgálatban az elektív splenectomiák messze leggyakoribb indikációját képező idiopátiás thrombocytopéniás purpurában (ITP) szenvedő betegek adatait a splenectomiára adott hematológiai válasz szempontjából elemeztük [4]. A kezelésre adott válasz definícióját 100 3 10 9 /l thrombocytaszám felett (complete response [CR]), illetve 30 és 100 3 10 9 /l között az alapérték minimum kétszeres emelkedésénél (response [R]) határoztuk meg.…”