Predictive Factors for Successful Laparoscopic Splenectomy in Patients With Immune Thrombocytopenic Purpura

Duperier, Terive; Brody, Fred; Felsher, Joshua; Walsh, R. Matthew; Rosen, Michael J.; Ponsky, Jeffrey L.

doi:10.1001/archsurg.139.1.61

Cited by 52 publications

(50 citation statements)

References 37 publications

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“…ITP was treated surgically even up to 1958, when Damashek et.al. described the term "hypersplenism" and demonstrated the significance of GC in the treatment of chronic ITP and established it as the first line of treatment (7,14). The side -effects of GC therapy and the development of minimally invasive surgical techniques facilitated the introduction of laparoscopic splenectomy in the treatment of ITP.…”

Section: Discussionmentioning

confidence: 99%

“…Literature reports that the type of operation does not affect the ITP outcome in a statistically significant way (5,11). One of the most frequently assessed factors, which could influence ITP outcome following an operation is age (3,7,8,14). In our study the mean value of the cured patients' age -34.6 ± 9.8 years is lower in a statistically significant way compared to those patients, who continue treatment or who have experienced transformation of the disease (F = 7.327; p = 0.011).…”

Section: Discussionmentioning

confidence: 99%

“…Kathkouda et al mention that the age from 30 to 45 years is an independent predictive factor for successful outcome following the operation (14). Duperier et al mention that patients, who are below 50 and who have undergone LS, have been successfully cured (7). It can be concluded that a more successful disease outcome following splenectomy can be predicted for younger patients.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have proven that LS is a safe and effective method for treating ITP, due to shorter period of hospitalization, quicker return to active life, smaller post-operative pain and number of complications, and better cosmetic effect compared to conventional splenectomy (CS). The surgical technique has no impact upon ITP outcome following the operation (3,7,12,14,16). Various sources of literature mention the range of ITP remission following splenectomy from 49 -93% (3,9,14,22,23).…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Predictive Factors Following Splenectomy for Complete Remission of Immune Thrombocytopenic Purpura

Vidmane-Ozola¹,

Boka²,

Cunskis

et al. 2010

Acta Chirurgica Latviensis

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28Summary Introduction. Immune thrombocytopenic purpura (ITP) is one of the most commonly known and widely researched haematological diseases. ITP manifests as decrease in platelet count of various degrees, which can even cause fatal bleeding from 0.4 -13% annually. Glucocorticoids (GC) and intravenous immunoglobulin (IgG) are used as the first line of treatment, 20-50% of drug therapy is ineffective and splenectomy is "the second stage" of treatment. Various sources of literature mention the range of ITP remission following splenectomy from 49 -93%. Current studies are looking for prognostic factors, which would ensure complete ITP remission following splenectomy. Aim of the Study. To analyse possible perioperative prognostic factors in ITP patients for achieving remission following splenectomy. Materials and methods. The retrospective study included 13 patients diagnosed with immune thrombocytopenic purpura (ITP), who underwent surgery in the period from 2002 to 2009 at the Riga Eastern Clinical University Hospital "Linezers". From laboratory tests -full blood-count 1 -2 days before the operation, on the 5th -7th day following the operation, 1 month after the operation, one year after the operation and during the last follow-up found in the patient's out-patient file. The size of the spleen before the surgery was determined by ultrasonography. The access to the abdominal cavity and the spleen -conventional or laparoscopic surgery, the duration of the operation, perioperative blood loss, post-operative complications and the patient's day of discharge following the surgery was analysed. Results. In the period from January 2002 to January 2009 at RECUH clinic "Linezers" 13 ITP patients underwent surgery. As to the gender the average age for both genders was similar (men 39.0 ± 14.1 and women 39.0 ± 16.0). The mean value of the duration of the disease in women (8.0 ± 9.0 months) and men (68.1 ± 58.7 months) has a statistically significant difference, using the independent pair selection t-test (t = 2.38; p = 0.047). In one US case and in one CT case accessory spleens were detected. The preoperative mean value of PLT count had increased in a statistically significant way in accordance with the independent pair selection t-test (t = 3.087; p = 0.009), and in accordance with Wilcoxon signed-rank test (z = 2,202; p = 0,028) compared to the mean value of PLT count, which was detected during the last follow-up visit on average 35.9 ± 35.9 months after the surgery. Analysis of variance (ANOVA) shows that the average age of cured patients 34.6 ± 9.8 is statistically less significant than for those patients, who continue treatment and whose disease has transformed (F = 7.327; p = 0.011). Conclusions. The performed research allows concluding that the decisive factors in successful ITP outcome after the operation are the following: 1) in patients, who have undergone the operation in a relatively younger age (34.6 ± 9.8 years) the disease outcome is more successful during the follow -up period -35.9 ± 35.9 months (F = 7.327; ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Perioperative Predictive Factors Following Splenectomy for Complete Remission of Immune Thrombocytopenic Purpura

Vidmane-Ozola¹,

Boka²,

Cunskis

et al. 2010

Acta Chirurgica Latviensis

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“…The remission index after splenectomy in case of ITP patients ranged between 64% and 90% (11)(12)(13)(14)(15)(16). In a meta-analysis, Kojouri and co-authors (135 investigations during the period between 1996 and 2004) examined the effect of splenectomy in patients with idiopathic thrombocytopenic purpura and demonstrated that the complete remission was 66% (2623 patients), while partial remission was observed in 88% of patients (8).…”

Section: 8%)mentioning

confidence: 99%

Splenectomy in Patients with Hematological Disorders - Our Experience

Zukrowski

Kielan

Grzebieniak

et al. 2007

Polish Journal of Surgery

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The aim of the study. Retrospective analysis of indications for splenectomy in hematological diseases, positive effect of this operation and correlations between objective prognostic factors and good response to splenectomy in patients with different hematological indications for splenectomy. Material and methods. 98 adult patients with hematological disorders, who were splenectomised in the years 1994 -2004. We evaluated the effects of splenectomy in patients with hematological diseases as defined by patient documentation from the 2 nd Department of General and Oncological Surgery, Department of Hematology and Hematological Ambulance and the questionnaires that patients completed by themselves. Results. The beneficial effect of splenectomy was observed in the majority of cases of idiopathic thrombocytopenic purpura (41 of 53 patients), acquired hemolytic anemia (2 of 3 patients) and hereditary spherocytosis (8 of 9 patients). Surgery can provide a high frequency of durable response for adult patients with benign hematological disorders. In malignant hematological diseases, splenectomy eliminates consequences of hypersplenism or splenomegaly. Splenectomy in patients with malignant hematological disorders can improve their condition and relieve symptoms of hypersplenism and splenomegaly to improve their quality of life. There were early complications in 11 patients (11.3%). Mortality was 2%. Late complications appeared in 24 patients out of 96 patients, who survived the perioperative period. The most common late complication was moderate respiratory infections. Conclusions. Splenectomy is the most common operation in patients with hematological disorders. Indications for splenectomy have been hindered by the lack of any objective prognostic factors of good postoperative response. Nevertheless, the effect of splenectomy is positive in many patients with benign and malignant hematological diseases. Key words: splenectomy, hematological diseases Splenectomy is the most common surgical procedure in patients with hematological disorders. In many hematological conditions, the physiological and pathological (hypersplenism) function of the spleen is regulated by the occurrence of numerous clinical symptoms. As a result, the removal of the above-mentioned organ should eliminate the basic chain link of the pathogenetic process. However, in some patients, splenectomy does not promote regression of clinical symptoms. Thus, the basic problem in splenic surgery is associated with the absence of indices, which would predict the distant effects of splenectomy.The aim of this study was to retrospectively determine the indications for splenectomy and its efficacy in adult patients with hematological disorders, as well as the influence of certain objective factors on the therapeutic effect of splenectomy.

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Liver and Spleen

Kulvatunyou

2012

Surgical Critical Care and Emergency Surgery

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Predictive Factors for Successful Laparoscopic Splenectomy in Patients With Immune Thrombocytopenic Purpura

Abstract: Hypothesis: Younger patients with immune thrombocytopenic purpura (ITP) and high preoperative platelet counts successfully respond to laparoscopic splenectomy (LS).

Cited by 52 publications

References 37 publications

Perioperative Predictive Factors Following Splenectomy for Complete Remission of Immune Thrombocytopenic Purpura

Perioperative Predictive Factors Following Splenectomy for Complete Remission of Immune Thrombocytopenic Purpura

Splenectomy in Patients with Hematological Disorders - Our Experience

Liver and Spleen

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