Predictors of response after laparoscopic splenectomy for immune thrombocytopenic purpura
- 87 Downloads
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 wordsImmune thrombocytopenic purpura Laparoscopy Predictors Splenectomy
Unable to display preview. Download preview PDF.
- 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
- 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.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
- 14.Katkhouda N (1998) Advanced laparoscopic surgery techniques and tips. 1st ed. WB Saunders, London, ppGoogle Scholar
- 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