Surgical Endoscopy

, Volume 15, Issue 5, pp 484–488 | Cite as

Predictors of response after laparoscopic splenectomy for immune thrombocytopenic purpura

  • N. Katkhouda
  • S. W. Grant
  • E. Mavor
  • M. H. Friedlander
  • R. V. Lord
  • K. Achanta
  • R. Essani
  • R. Mason
Original Articles



Splenectomy has been shown to produce longterm remission in patients with immune thrombocytopenic purpura (ITP). With the development of laparoscopic splenectomy, there is renewed interest in the surgical treatment of ITP. The aim of this study was to identify factors that are predictive of outcome after laparoscopic splenectomy for ITP.


A case series of 67 consecutive patients with ITP undergoing laparoscopic splenectomy was reviewed. A positive response was defined as a postoperative platelet count greater than 150,000/μl requiring no maintenance medical therapy on follow-up evaluation. A chi-square test and a stepwise logistic regression analysis were performed for the following variables: age, gender, preoperative response to steroids, duration of disease, severity of preoperative bleeding, accessory spleens, and thrombocytosis on discharge.


At a median follow-up period of 38 months (range, 2–56 months), 52 patients (78%) had a positive response to laparoscopic splenectomy. Of the 15 patients (22%) who did not have a positive response, 11 were refractory and 4 relapsed. All relapses occurred in patients with a platelet count less than 150,000/μl at discharge. Patient age was the most significant predictive factor for success or failure of the operation. The median age of the responders (31 years; range, 19–71 years) was significantly lower than the median age of the nonresponders (49 years; range, 24–62; p<0.001). Only 5.6% of those younger than 40 years did not have a positive response, compared with 42% of patients older than 40 years (p<0.05). Patient age was significantly associated with outcome on univariable chi-square analysis (p=0.001), and was the only significant factor on multivariable analysis (odds ratio, 2.65; 95% confidence interval, 1.71–4.1). Other significant predictors of outcome on univariable analysis were preoperative response to corticosteroids and platelet count on discharge.


A long-lasting response after splenectomy for ITP is more likely to occur in patients younger than 40 years of age. To avoid the long-term side effects of corticosteroid use, early surgical referral of younger patients with ITP should be considered.

Key words

Immune thrombocytopenic purpura Laparoscopy Predictors Splenectomy 


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  1. 1.
    Akwari OE, Itani KM, Coleman RE, Rosse WF (1987) Splenectomy for primary and recurrent immune thrombocytopenic purpura. Ann Surg 206: 529–541PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Ballem PJ, Segal GM, Stratton JR, Gernsheimer T, Adamson JW, Slicher SJ (1987) Mechanism of thrombocytopenia in chronic auto-immune thrombocytopenic pupura: evidence of both impaired platelet production and increased platelet clearance. J Clin Invest 80: 33–40PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Brennan MF, Rappaport JM, Moloney WC, Wilson RE (1975) Correlation between response to corticosteroids and splenectomy for adult idiopathic thrombocytopenic purpura. Am J Surg 129: 490–492PubMedCrossRefGoogle Scholar
  4. 4.
    Brunt ML, Langer JC, Quasebarth MA, Whitman ED (1996) Comparative analysis of laparoscopic versus open splenectomy. Am J Surg 172: 596–601PubMedCrossRefGoogle Scholar
  5. 5.
    Delaitre B, Maignien B, Icard P (1992) Laparoscopic splenectomy. Br J Surg 79: 1334PubMedCrossRefGoogle Scholar
  6. 6.
    Difino SM, Lachant NA, Kirshner JJ, Gottlieb AJ (1980) Adult idiopathic thrombocytopenic purpura: clinical findings and response to therapy. Am J Med 69: 430–442PubMedCrossRefGoogle Scholar
  7. 7.
    Fabris F, Zanatta N, Casonato A, Randi ML, Luzzatto G, Girolami A (1989) Response to splenectomy in idiopathic thrombocytopenic purpura: prognostic value of the clinical and laboratory evaluation. Acta Haem 81: 28–33CrossRefGoogle Scholar
  8. 8.
    Fenaux P, Caulier MT, Hirschhauer MC, Beuscart R, Goudemand J, Bauters F (1989) Reevaluation of the prognostic factors for splenectomy in chronic idiopathic thrombocytopenic purpura: a report on 181 cases. Euro J Haem 42: 259–264CrossRefGoogle Scholar
  9. 9.
    Flowers JL, Lefor AT, Steers J, Heyman M, Graham S, Imbembo AL (1996) Laparoscopic splenectomy in patients with hematologic diseases. Ann Surg 224: 19–28PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballem PJ, Blanchette VS, Bussel JB, Cines DB, Kelton JG, Lichtin AE, McLillan R, Okerbloom JA, Regan DH, Warrier I (1996) Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 88: 3–40PubMedGoogle Scholar
  11. 11.
    Gigot J-F, Legrand M, Cadiere G-B, Delvaux G, deGoyet JD, deRoden AD, Van Vyke E, Hourlay P, Etienne J, Njinou B, Collard A (1995) Is laparoscopic splenectomy a justified approach in hematologic disorders? Preliminary results of a prospective multicenter study. Int Surg 80: 299–303PubMedGoogle Scholar
  12. 12.
    Harold KL, Schlinkert RT, Mann DK, Reeder CB, Noel P, Fitch TR, Braich TA, Camoriano JK (1999) Long-term results of laparoscopic splenectomy for immune thrombocytopenic purpura. Mayo Clin Proc 74: 37–39PubMedCrossRefGoogle Scholar
  13. 13.
    Julia A, Araguas C, Rossello J, Bueno J, Domenech P, Olona M, Guardia R, Petit J, Flores A (1990) Lack of useful clinical predictors of response to splenectomy in patients with chronic idiopathic thrombocytopenic purpura. Br J Haem 76: 250–255CrossRefGoogle Scholar
  14. 14.
    Katkhouda N (1998) Advanced laparoscopic surgery techniques and tips. 1st ed. WB Saunders, London, ppGoogle Scholar
  15. 15.
    Katkhouda N, Hurwitz MB, Rivera RT, Chandra M, Waldrep DJ, Gugenheim J, Mouiel J (1998) Laparoscopic splenectomy: outcome and efficacy in 103 consecutive patients. Ann Surg 228: 568–577PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Law C, Marcaccio M, Tam P, Heddle N, Kelton JG (1997) High-dose intravenous immune globulin and the response to splenectomy in patients with idiopathic thrombocytopenic purpura. N Engl J Med 336: 1494–1498PubMedCrossRefGoogle Scholar
  17. 17.
    Lozano-Salazar RR, Herrera MF, Vargas-Vorackova F, Lopez-Karpovitch X (1998) Laparoscopic versus open splenectomy for immune thrombocytopenic purpura. Am J Surg 176: 366–369PubMedCrossRefGoogle Scholar
  18. 18.
    McMillan R (1997) Therapy for adults with refractory chronic immune thrombocytopenic purpura. Ann Int Med 126: 307–314PubMedCrossRefGoogle Scholar
  19. 19.
    Najean Y, Dufour J, Rain D, Toubert ME (1991) The site of platelet destruction in thrombocytopenic purpura as a predictive index of the efficacy of splenectomy. Br J Haem 79: 271–376CrossRefGoogle Scholar
  20. 20.
    Position Paper of the American Society of Hematology ITP Practice Guideline Panel Diagnosis and treatment of idiopathic thrombocytopenic purpura: recommendations of the American Society of Hematology. Ann Int Med 126: 319–326Google Scholar
  21. 21.
    Schwartz SI (1996) Role of splenectomy in hematologic disorders. World J Surg 20: 1156–1159PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2001

Authors and Affiliations

  • N. Katkhouda
    • 1
  • S. W. Grant
    • 1
  • E. Mavor
    • 1
  • M. H. Friedlander
    • 1
  • R. V. Lord
    • 1
  • K. Achanta
    • 1
  • R. Essani
    • 1
  • R. Mason
    • 1
  1. 1.Department of Surgery, Division of Emergency Non Trauma and Minimally Invasive SurgeryUniversity of Southern California School of MedicineLos AngelesUSA

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