Combined subtotal gastrectomy and splenectomy after partial splenic embolization for a patient with gastric cancer and immune thrombocytopenic purpura: A case report

Kaneko, Yuki; Saito, Shin; Takahashi, Daijiro; Ui, Takashi; Higashi, Hidenori; Kurashina, Kentaro; Yamaguchi, Hironori; Hosoya, Yoshinori; Kitayama, Joji; Lefor, Alan Kawarai; Sata, Naohiro

doi:10.1016/j.ijscr.2019.08.027

Cited by 2 publications

(4 citation statements)

References 16 publications

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“…We identified 109 citations through our comprehensive literature search, of which 49 citations were retrieved for detailed review (Figure 1). Twelve citations (22 patients) described the use of SE for the treatment of ITP but only as a bridging therapy prior to splenectomy 22–33 . These studies could not be used for the analysis of effectiveness.…”

Section: Resultsmentioning

confidence: 99%

“…It is noteworthy to highlight the utilization of SE as a bridging therapy before splenectomy to reduce the risk of perioperative bleeding, or the need of perioperative red blood cell (RBC) or platelet transfusion 22–33,65 . In addition, SE has been successfully applied to treat refractoriness to RBC transfusion secondary to hypersplenism, potentially predicting the utility of subsequent splenectomy 66–68 .…”

Section: Discussionmentioning

confidence: 99%

“…Twelve citations (22 patients) described the use of SE for the treatment of ITP but only as a bridging therapy prior to splenectomy. [22][23][24][25][26][27][28][29][30][31][32][33] These studies could not be used for the analysis of effectiveness. After exclusion of review publications and duplicate reports, 24 reports were included in the final analysis.…”

Section: R E Su Ltsmentioning

confidence: 99%

“…It is noteworthy to highlight the utilization of SE as a bridging therapy before splenectomy to reduce the risk of perioperative bleeding, or the need of perioperative red blood cell (RBC) or platelet transfusion. [22][23][24][25][26][27][28][29][30][31][32][33]65 In addition, SE has been successfully applied to treat refractoriness to RBC transfusion secondary to hypersplenism, potentially predicting the utility of subsequent splenectomy. [66][67][68] Furthermore, though not included in the analysis of effectiveness, we identified 11 citations that described the successful use of SE in young and adult patients with ITP who were considered unsuitable candidates for splenectomy, 16,17,41,42,44,[69][70][71][72] declined surgery 73 or individuals who experienced ITP relapse post-splenectomy due to accessory spleen.…”

Section: Study Year (Reference)mentioning

confidence: 99%

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The use of splenic embolization in immune thrombocytopenia: A systematic review and meta‐analysis

Egbaria,

Touma,

Cohen‐Abadi

et al. 2024

Br J Haematol

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SummaryThe effectiveness of splenic embolization (SE) in treating refractory immune thrombocytopenia (ITP) remains uncertain. A systematic literature review was undertaken to assess the effectiveness and safety of SE in treating both paediatric and adult patients with ITP. We conducted an extensive search employing predefined criteria. We extracted platelet counts at baseline and at multiple intervals following SE, along with details of the proportion of embolized spleen parenchyma and the proportion of patients exhibiting complete or partial platelet count responses. We identified nine eligible reports for the analysis of effectiveness (228 patients) and 15 reports for the safety analysis (151 patients). Pooled estimates of complete response (platelet count >100 × 109/L) and overall response (platelet count >30 × 109/L) were 50.1% (95% CI: 38–62.3) and 74.4% (95% CI: 64.9–83.9) respectively. Most studies applied an embolization of at least 60% of the spleen parenchyma. Nearly all the patients suffered from mild adverse events (AEs), 1.3% suffered from serious AEs and one patient died (0.7%). In conclusion, SE resulted in an overall response rate in 74.4% of patients with ITP. However, this finding derives from uncontrolled studies of low to moderate quality.

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Section: Resultsmentioning

confidence: 99%

“…It is noteworthy to highlight the utilization of SE as a bridging therapy before splenectomy to reduce the risk of perioperative bleeding, or the need of perioperative red blood cell (RBC) or platelet transfusion 22–33,65 . In addition, SE has been successfully applied to treat refractoriness to RBC transfusion secondary to hypersplenism, potentially predicting the utility of subsequent splenectomy 66–68 .…”

Section: Discussionmentioning

confidence: 99%

Section: R E Su Ltsmentioning

confidence: 99%

“…It is noteworthy to highlight the utilization of SE as a bridging therapy before splenectomy to reduce the risk of perioperative bleeding, or the need of perioperative red blood cell (RBC) or platelet transfusion. [22][23][24][25][26][27][28][29][30][31][32][33]65 In addition, SE has been successfully applied to treat refractoriness to RBC transfusion secondary to hypersplenism, potentially predicting the utility of subsequent splenectomy. [66][67][68] Furthermore, though not included in the analysis of effectiveness, we identified 11 citations that described the successful use of SE in young and adult patients with ITP who were considered unsuitable candidates for splenectomy, 16,17,41,42,44,[69][70][71][72] declined surgery 73 or individuals who experienced ITP relapse post-splenectomy due to accessory spleen.…”

Section: Study Year (Reference)mentioning

confidence: 99%

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The use of splenic embolization in immune thrombocytopenia: A systematic review and meta‐analysis

Egbaria,

Touma,

Cohen‐Abadi

et al. 2024

Br J Haematol

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The Many Faces of Immune Thrombocytopenia: Mechanisms, Therapies, and Clinical Challenges in Oncological Patients

Kos,

Tomaka,

Mertowska

et al. 2024

JCM

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The pathogenesis of immune thrombocytopenia (ITP) is complex and involves the dysregulation of immune cells, such as T and B lymphocytes, and several cytokines that promote the production of autoantibodies. In the context of cancer patients, ITP can occur in both primary and secondary forms related to anticancer therapies or the disease itself. Objective: In light of these data, we decided to prepare a literature review that will explain the classification and immunological determinants of the pathogenesis of ITP and present the clinical implications of this condition, especially in patients with cancer. Materials and methods: We reviewed the literature on immunological mechanisms, therapies, and challenges in treating ITP, particularly on cancer patients. Results: The results of the literature review show that ITP in cancer patients can be both primary and secondary, with secondary ITP being more often associated with anticancer therapies such as chemotherapy and immunotherapy. Innovative therapies such as TPO-RA, rituximab, Bruton’s kinase inhibitors, and FcRn receptor inhibitors have shown promising results in treating refractory ITP, especially in patients with chronic disease. Conclusions: ITP is a significant clinical challenge, especially in the context of oncology patients, where both the disease and treatment can worsen thrombocytopenia and increase the risk of bleeding complications. Treatment of oncology patients with ITP requires an individualized approach, and new therapies offer effective tools for managing this condition. Future research into immunological mechanisms may bring further advances in treating ITP and improve outcomes in cancer patients.

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Combined subtotal gastrectomy and splenectomy after partial splenic embolization for a patient with gastric cancer and immune thrombocytopenic purpura: A case report

Cited by 2 publications

References 16 publications

The use of splenic embolization in immune thrombocytopenia: A systematic review and meta‐analysis

The use of splenic embolization in immune thrombocytopenia: A systematic review and meta‐analysis

The Many Faces of Immune Thrombocytopenia: Mechanisms, Therapies, and Clinical Challenges in Oncological Patients

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