Skip to main content
SpringerLink
Log in

Factors Predicting Long-term Responses to Splenctomy in Patients with Idiopathic Thrombocytopenic Purpura

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder for which appropriate diagnostic treatments are uncertain. The response to splenectomy varies from 60% to 90%, and the remaining patients relapse and require further treatment. Therefore, it is important to predict the outcome of splenectomy before and after surgery. The objective of this study was to evaluate the efficacy of splenectomy in patients diagnosed with ITP.

Materials and Methods

From 1988 to 2004, we splenectomized 32 patients with ITP; 17 underwent laparoscopic splenectomy (LS) and 15 underwent conventional open splenectomy (OS). For analysis, patients were separated retrospectively into two groups: the “responding group,” those who showed good outcomes with splenectomy, and the “non-responding group,” those who did not show good outcomes with splenectomy. Blood samples were examined before and immediately after surgery (day 0) and on postoperative days (POD) 1, 3, 5, and 7.

Results

The median follow-up was 8.3 years (range: 1–16 years). The overall 5- and 10-year survival rates after splenectomy were 96.9% (one death). The responding group included 24 patients (75%), and the non-responding group included 7 (21.9%). Platelet counts in the responding group increased gradually until POD 7, and although platelet counts in the non-responding group were almost constant until POD 5, they subsequently decreased until POD 7. Average platelet counts in the responding and non-responding groups were 269 and 124 × 109/l on POD 7, respectively (P < 0.05). The pre- to post-surgery ratio of platelet counts were almost the same as the result of the actual data. Platelet counts during the long-term follow-up for the responding and non-responding groups were related to those noted on discharge.

Conclusions

A high platelet count on POD 7 was associated with a good response to splenectomy, but age at surgery, the time interval between diagnosis and splenectomy, and prior responses to corticosteroid were not. We suggest that long-term outcomes of splenectomy can easily be predicted by platelet counts on POD 7.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  1. Fenaux P, Caulier MT, Hirschauer MC, et al. Reevaluation of the prognostic factors for splenectomy in chronic idiopathic thrombocytopenic purpura (ITP): a report on 181 cases. Eur J Haematol 1989;42:259–264

    PubMed  CAS  Google Scholar 

  2. Najean Y, Ardaillou N. The sequestration site of platelets in idiopathic thrombocytopenic purpura: its correlation with the results of splenectomy. Br J Haematol 1971;21:153–164

    PubMed  CAS  Google Scholar 

  3. Akwari OE, Itani KM, Coleman RE, et al. Splenectomy for primary and recurrent immune thrombocytopenic purpura (ITP). Current criteria for patient selection and results. Ann Surg 1987;206:529–541

    PubMed  CAS  Google Scholar 

  4. Gugliotta L, Isacchi G, Guarini A, et al. Chronic idiopathic thrombocytopenic purpura (ITP): site of platelet sequestration and results of splenectomy. A study of 197 patients. Scand J Haematol 1981;26:407–412

    PubMed  CAS  Google Scholar 

  5. Diaz J, Eisenstat M, Chung RS. Laparoscopic resection of accessory spleen for recurrent immune thrombocytopenic purpura 19 years after splenectomy. J Laparoendosc Surg 1996; 6:337–339

    PubMed  CAS  Google Scholar 

  6. Mazzucconi MG, Arista MC, Peraino M, et al. Long-term follow-up of autoimmune thrombocytopenic purpura (ATP) patients submitted to splenectomy. Eur J Haematol 1999;62:219–222

    PubMed  CAS  Google Scholar 

  7. Szold A, Schwartz J, Abu-Abeid S, et al. Laparoscopic splenectomies for idiopathic thrombocytopenic purpura: experience of sixty cases. Am J Hematol 2000;63:7–10

    Article  PubMed  CAS  Google Scholar 

  8. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med 2002;28;346:995–1008

    Google Scholar 

  9. Maloisel F, Andres E, Zimmer J, et al. Danazol therapy in patients with chronic idiopathic thrombocytopenic purpura: long-term results. Am J Med 2004;116:590–594

    Article  PubMed  CAS  Google Scholar 

  10. Delaitre B, Maignien B. Splenectomy by the laparoscopic approach. Report of a case Presse Med 1991;20:2263

    CAS  Google Scholar 

  11. Friedman RL, Hiatt JR, Korman JL, et al. Laparoscopic or open splenectomy for hematologic disease: which approach is superior? J Am Coll Surg 1997;185:49–54

    PubMed  CAS  Google Scholar 

  12. Park A, Marcaccio M, Sternbach M, et al. Laparoscopic vs open splenectomy. Arch Surg. 1999;134:1263–1269

    PubMed  CAS  Google Scholar 

  13. Watson DI, Coventry BJ, Chin T, et al. Laparoscopic versus open splenectomy for immune thrombocytopenic purpura. Surgery 1997;121:18–22

    Article  PubMed  CAS  Google Scholar 

  14. Berchtold P, McMillan R. Therapy of chronic idiopathic thrombocytopenic purpura in adults. Blood 1989;74:2309–2317

    PubMed  CAS  Google Scholar 

  15. Zoghlami-Rintelen C, Weltermann A, Bittermann C, et al. Efficacy and safety of splenectomy in adult chronic immune thrombocytopenia. Ann Hematol 2003;82:290–294

    PubMed  CAS  Google Scholar 

  16. Bourgeois E, Caulier MT, Delarozee C, et al. Long-term follow-up of chronic autoimmune thrombocytopenic purpura refractory to splenectomy: a prospective analysis. Br J Haematol 2003;120:1079–1088

    Article  PubMed  Google Scholar 

  17. Najean Y, Rain JD, Billotey C. The site of destruction of autologous 111In-labelled platelets and the efficiency of splenectomy in children and adults with idiopathic thrombocytopenic purpura: a study of 578 patients with 268 splenectomies. Br J Haematol 1997;97:547–550

    Article  PubMed  CAS  Google Scholar 

  18. Najean Y, Dufour V, Rain JD, et al. The site of platelet destruction in thrombocytopenic purpura as a predictive index of the efficacy of splenectomy. Br J Haematol 1991;79:271–276

    PubMed  CAS  Google Scholar 

  19. Zimmer J, Andres E, Noel E, et al. Current management of adult idiopathic thrombocytopenic purpura in practice: a cohort study of 201 patients from a single center. Clin Lab Haematol 2004;26:137–142

    Article  PubMed  CAS  Google Scholar 

  20. El-Alfy MS, El-Tawil MM, Shahein N. 5- to 16-year follow-up following splenectomy in chronic immune thrombocytopenic purpura in children. Acta Haematol 2003;110:20–24

    Article  PubMed  Google Scholar 

  21. Vianelli N, Valdre L, Fiacchini M, et al. Long-term follow-up of idiopathic thrombocytopenic purpura in 310 patients. Haematologica 2001;86:504–509

    PubMed  CAS  Google Scholar 

  22. Portielje JE, Westendorp RG, Kluin-Nelemans HC, et al. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood 2001;97:2549–2554

    Article  PubMed  CAS  Google Scholar 

  23. Machado MA, Makdissi FF, Herman P, et al. Exposure of splenic hilum increases safety of laparoscopic splenectomy. Surg Laparosc Endosc Percutan Tech. 2004;14:23–25

    PubMed  Google Scholar 

  24. Kercher KW, Novitsky YW, Czerniach DR, et al. Staple line bleeding following laparoscopic splenectomy: intraoperative prevention and postoperative management with splenic artery embolization. Surg Laparosc Endosc Percutan Tech 2003;13:353–356

    PubMed  Google Scholar 

  25. Iwase K, Higaki J, Yoon HE, et al. Splenic artery embolization using contour emboli before laparoscopic or laparoscopically assisted splenectomy. Surg Laparosc Endosc Percutan Tech 2002;12:331–336

    Article  PubMed  Google Scholar 

  26. Totte E, Van Hee R, Kloeck I, et al. Laparoscopic splenectomy after arterial embolisation. Hepatogastroenterology 1998;45:773–776

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Gunma Prefecture Saiseikai-Maebashi Hospital, 564-1 Kami-shinden, Maebashi, 371-0821, Japan

    Hitoshi Ojima MD, PhD, Toshihide Kato MD, Kenichirou Araki MD, Kaori Okamura MD, Ryokuhei Manda MD, PhD, Isao Hirayama MD, PhD, Yasuo Hosouchi MD, PhD & Yasuji Nishida MD, PhD

  2. Department of General Surgical Science, Gunma University Faculty of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan

    Hitoshi Ojima MD, PhD & Hiroyuki Kuwano MD, PhD

Authors
  1. Hitoshi Ojima MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toshihide Kato MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenichirou Araki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kaori Okamura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryokuhei Manda MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Isao Hirayama MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yasuo Hosouchi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yasuji Nishida MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroyuki Kuwano MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hitoshi Ojima MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ojima, H., Kato, T., Araki, K. et al. Factors Predicting Long-term Responses to Splenctomy in Patients with Idiopathic Thrombocytopenic Purpura. World J. Surg. 30, 553–559 (2006). https://doi.org/10.1007/s00268-005-7964-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-005-7964-0

Keywords

Search

Navigation