Top

Published in:

01-10-2016 | original article

Laparoscopic splenectomy for second-line treatment of immune thrombocytopenia – analysis of 53 patients and current perspectives

Laparoscopic splenectomy for immune thrombocytopenia

Authors: André Costa-Pinho, MD, Diana Fernandes, MD, Renato Bessa-Melo, MD, Marisa Aral, MD, Luís Graça, MD, José Costa-Maia, MD

Published in: European Surgery | Issue 5/2016

Summary

Background

Splenectomy is a well-established second-line treatment for immune thrombocytopenia but novel medical therapies have changed the management of this disease. The objective of this study is to analyze the current results of splenectomy as a second-line treatment.

Methods

Retrospective analysis of 53 consecutive patients with chronic immune thrombocytopenia submitted to splenectomy from January 2007 through December 2014. Several parameters were analyzed including postoperative morbidity and outcomes after surgery.

Results

Fifty-two (98%) patients underwent successful laparoscopic splenectomy without conversion to open procedure, with a mean operative time of 103.6 ± 38.1 minutes. The median postoperative length of stay was 3 days (range 1–36 days). There were 3 (5.7%) major postoperative complications resulting in 2 (3.8%) reoperations. No splenectomy-related mortalities occurred. Fifty (94.3%) patients presented a response 1 month after surgery (45 complete responses and 5 responses). In the follow-up (mean 24.8 ± 16.9 months) 37 (75.5%) patients had a complete and sustained response after laparoscopic splenectomy and an additional 11 (22.4%) presented platelet counts above 30×10⁹/L (the majority of these patients eventually reaching normal platelet counts). No additional therapies were needed in 39 (79.6%) patients after surgery.

Conclusions

In our experience, laparoscopic splenectomy is an effective second-line treatment for Immune Thrombocytopenia with short and long-term response rates of 94% and 91%, respectively. Major postoperative complications occurred in 6%. Future research should aim to discover new methods to properly select patients to different second-line treatments.

Segal JB, Powe NR. Prevalence of immune thrombocytopenia: analyses of administrative data. J Thromb Haemost. 2006;4(11):2377–83.CrossRefPubMed

Schipperus M, Fijnheer R. New therapeutic options for immune thrombocytopenia. Neth J Med. 2011;69(11):480–5.PubMed

Rodeghiero F, Ruggeri M. Is splenectomy still the gold standard for the treatment of chronic ITP? Am J Hematol. 2008;83(2):91.CrossRefPubMed

Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2009;115(2):168–86.CrossRefPubMed

Neunert C, Lim W, Crowther M, Cohen A, Solberg L, Crowther MA. The american society of hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190–207.CrossRefPubMed

Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113(11):2386–93.CrossRefPubMed

Dindo D, Demartines N, Clavien P‑A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentral

Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot J‑F, Leandros E, et al. Laparoscopic splenectomy: the clinical practice guidelines of the European association for endoscopic surgery (EAES). Surg Endosc. 2008;22(4):821–48.CrossRefPubMed

Mikhael J, Northridge K, Lindquist K, Kessler C, Deuson R, Danese M. Short-term and long-term failure of laparoscopic splenectomy in adult immune thrombocytopenic purpura patients: a systematic review. Am J Hematol. 2009;84(11):743–8.CrossRefPubMed

10.

Kojouri K, Vesely SK, Terrell DR, George JN. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood. 2004;104(9):2623–34.CrossRefPubMed

11.

Vianelli N, Galli M, de Vivo A, Intermesoli T, Giannini B, Mazzucconi MG, et al. Efficacy and safety of splenectomy in immune thrombocytopenic purpura: long-term results of 402 cases. Haematologica. 2005;90(1):72–7.PubMed

12.

Schwartz J, Leber MD, Gillis S, Giunta A, Eldor A, Bussel JB. Long term follow-up after splenectomy performed for immune thrombocytopenic purpura (ITP). Am J Hematol. 2003;72(2):94–8.CrossRefPubMed

13.

Ghanima W, Khelif A, Waage A, Michel M, Tjønnfjord GE, Romdhan NB, et al. Rituximab as second-line treatment for adult immune thrombocytopenia (the RITP trial): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2015;385(9978):1653–61.CrossRefPubMed

14.

Vianelli N, Palandri F, Polverelli N, Stasi R, Joelsson J, Johansson E, et al. Splenectomy as a curative treatment for immune thrombocytopenia: a retrospective analysis of 233 patients with a minimum follow up of 10 years. Haematologica. 2013;98(6):875–80.CrossRefPubMedPubMedCentral

15.

Ghanima W, Godeau B, Cines DB, Bussel JB. How I treat immune thrombocytopenia: the choice between splenectomy or a medical therapy as a second-line treatment. Blood. 2012;120(5):960–9.CrossRefPubMed

16.

Kimura F, Itoh H, Ambiru S, Shimizu H, Togawa A, Yoshidome H, et al. Long-term results of initial and repeated partial splenic embolization for the treatment of chronic idiopathic thrombocytopenic purpura. AJR Am J Roentgenol. 2002;179(5):1323–6.CrossRefPubMed

17.

Sarpatwari A, Provan D, Erqou S, Sobnack R, David Tai FW, Newland AC. Autologous 111 In-labelled platelet sequestration studies in patients with primary immune thrombocytopenia (ITP) prior to splenectomy: a report from the United Kingdom ITP Registry. Br J Haematol. 2010;151(5):477–87.CrossRefPubMed

Title: Laparoscopic splenectomy for second-line treatment of immune thrombocytopenia – analysis of 53 patients and current perspectives
Laparoscopic splenectomy for immune thrombocytopenia
Authors: André Costa-Pinho, MD
Diana Fernandes, MD
Renato Bessa-Melo, MD
Marisa Aral, MD
Luís Graça, MD
José Costa-Maia, MD
Publication date: 01-10-2016
Publisher: Springer Vienna
Published in: European Surgery / Issue 5/2016
Print ISSN: 1682-8631
Electronic ISSN: 1682-4016
DOI: https://doi.org/10.1007/s10353-016-0394-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopic splenectomy for second-line treatment of immune thrombocytopenia – analysis of 53 patients and current perspectives

Laparoscopic splenectomy for immune thrombocytopenia

Summary

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Summary

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2016

Surgical use of fibrin glue-coated collagen patch for non-hemostatic indications

Video-assisted mediastinoscopic removal of ectopic parathyroid adenoma combined with standard cervical exploration

Esophagectomy for eosinophilic esophagitis: how to avoid it

Celiac artery compression of patients undergoing pancreatic surgery – a case series

Targeted therapy in gastric cancer

Hepatic hydatid cysts