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Published in: BMC Surgery 1/2018

Open Access 01-12-2018 | Research article

Platelet count on preoperative day 1 predicts the long-term responses to laparoscopic splenectomy for Chinese patients with medically refractory idiopathic thrombocytopenic purpura

Authors: Rui Liao, Pei-Yuan Tang, Jun-Feng Song, Ke-Le Qin, Xun Wang, Xiong Yan

Published in: BMC Surgery | Issue 1/2018

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Abstract

Background

Laparoscopic splenectomy (LS) is regarded as a second-line treatment for medically refractory idiopathic thrombocytopenic purpura (ITP), but the predictive factors for the long-term postoperative responses to ITP are still a matter of debate. We aimed to investigate the factors that can predict the long-term response after LS for Chinese patients with medically refractory ITP.

Methods

From January 2011 to September 2016, 78 Chinese patients with ITP who underwent LS were retrospectively analyzed. Twelve parameters were analyzed by univariate and multivariate methods.

Results

Univariate analysis revealed that platelet count on preoperative day (PRD) 1 (P < 0.001) and operative time (P = 0.011) were significantly associated with long-term response of ITP after LS. Multivariate analysis revealed that platelet count on PRD 1 was a predictive factor of long-term response (P < 0.001). Furthermore, a long-term, stable response of platelet count on PRD 1 of > 30.0 × 109/L was easier to achieve than a platelet count on PRD 1 ≤ 30.0 × 109/L after LS for ITP.

Conclusions

LS is a valuable and effective option in the treatment of medically refractory ITP. Platelet count on PRD 1 is an independent predicting factor for long-term response after LS for Chinese patients with ITP.
Literature
1.
go back to reference Cooper N. State of the art - how I manage immune thrombocytopenia. Br J Haematol. 2017;177(1):39–54.CrossRef Cooper N. State of the art - how I manage immune thrombocytopenia. Br J Haematol. 2017;177(1):39–54.CrossRef
2.
go back to reference Zhang J, Liang Y, Ai Y, Li X, Xie J, Li Y, Zheng W, He R. Eltrombopag versus romiplostim in treatment of adult patients with immune thrombocytopenia: a systematic review incorporating an indirect-comparison meta-analysis. PLoS One. 2018;13(6):e0198504.CrossRef Zhang J, Liang Y, Ai Y, Li X, Xie J, Li Y, Zheng W, He R. Eltrombopag versus romiplostim in treatment of adult patients with immune thrombocytopenia: a systematic review incorporating an indirect-comparison meta-analysis. PLoS One. 2018;13(6):e0198504.CrossRef
3.
go back to reference Grainger JD, Locatelli F, Chotsampancharoen T, Donyush E, Pongtanakul B, Komvilaisak P, Sosothikul D, Drelichman G, Sirachainan N, Holzhauer S, et al. Eltrombopag for children with chronic immune thrombocytopenia (PETIT2): a randomised, multicentre, placebo-controlled trial. Lancet. 2015;386(10004):1649–58.CrossRef Grainger JD, Locatelli F, Chotsampancharoen T, Donyush E, Pongtanakul B, Komvilaisak P, Sosothikul D, Drelichman G, Sirachainan N, Holzhauer S, et al. Eltrombopag for children with chronic immune thrombocytopenia (PETIT2): a randomised, multicentre, placebo-controlled trial. Lancet. 2015;386(10004):1649–58.CrossRef
4.
go back to reference Tarantino MD, Bussel JB, Blanchette VS, Despotovic J, Bennett C, Raj A, Williams B, Beam D, Morales J, Rose MJ, et al. Romiplostim in children with immune thrombocytopenia: a phase 3, randomised, double-blind, placebo-controlled study. Lancet. 2016;388(10039):45–54.CrossRef Tarantino MD, Bussel JB, Blanchette VS, Despotovic J, Bennett C, Raj A, Williams B, Beam D, Morales J, Rose MJ, et al. Romiplostim in children with immune thrombocytopenia: a phase 3, randomised, double-blind, placebo-controlled study. Lancet. 2016;388(10039):45–54.CrossRef
5.
go back to reference Chater C, Terriou L, Duhamel A, Launay D, Chambon JP, Pruvot FR, Rogosnitzky M, Zerbib P. Reemergence of splenectomy for ITP second-line treatment? Ann Surg. 2016;264(5):772–7.CrossRef Chater C, Terriou L, Duhamel A, Launay D, Chambon JP, Pruvot FR, Rogosnitzky M, Zerbib P. Reemergence of splenectomy for ITP second-line treatment? Ann Surg. 2016;264(5):772–7.CrossRef
6.
go back to reference Ojima H, Kato T, Araki K, Okamura K, Manda R, Hirayama I, Hosouchi Y, Nishida Y, Kuwano H. Factors predicting long-term responses to splenectomy in patients with idiopathic thrombocytopenic purpura. World J Surg. 2006;30(4):553–9.CrossRef Ojima H, Kato T, Araki K, Okamura K, Manda R, Hirayama I, Hosouchi Y, Nishida Y, Kuwano H. Factors predicting long-term responses to splenectomy in patients with idiopathic thrombocytopenic purpura. World J Surg. 2006;30(4):553–9.CrossRef
7.
go back to reference Kang CM, Lee JG, Kim KS, Choi JS, Lee WJ, Kim BR, Ko YW, Han JS, Min YH. Long-term follow-up of laparoscopic splenectomy in patients with immune thrombocytopenic purpura. J Korean Med Sci. 2007;22(3):420–4.CrossRef Kang CM, Lee JG, Kim KS, Choi JS, Lee WJ, Kim BR, Ko YW, Han JS, Min YH. Long-term follow-up of laparoscopic splenectomy in patients with immune thrombocytopenic purpura. J Korean Med Sci. 2007;22(3):420–4.CrossRef
8.
go back to reference Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA. 0The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190–207.CrossRef Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA. 0The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190–207.CrossRef
9.
go back to reference Gonzalez-Porras JR, Escalante F, Pardal E, Sierra M, Garcia-Frade LJ, Redondo S, Arefi M, Aguilar C, Ortega F, de Cabo E, et al. Safety and efficacy of splenectomy in over 65-yrs-old patients with immune thrombocytopenia. Eur J Haematol. 2013;91(3):236–41.CrossRef Gonzalez-Porras JR, Escalante F, Pardal E, Sierra M, Garcia-Frade LJ, Redondo S, Arefi M, Aguilar C, Ortega F, de Cabo E, et al. Safety and efficacy of splenectomy in over 65-yrs-old patients with immune thrombocytopenia. Eur J Haematol. 2013;91(3):236–41.CrossRef
10.
go back to reference 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.PubMed 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.PubMed
11.
go back to reference Sampath S, Meneghetti AT, MacFarlane JK, Nguyen NH, Benny WB, Panton ON. An 18-year review of open and laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Am J Surg. 2007;193(5):580–3.CrossRef Sampath S, Meneghetti AT, MacFarlane JK, Nguyen NH, Benny WB, Panton ON. An 18-year review of open and laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Am J Surg. 2007;193(5):580–3.CrossRef
12.
go back to reference Wang M, Zhang M, Zhou J, Wu Z, Zeng K, Peng B, Niu T. Predictive factors associated with long-term effects of laparoscopic splenectomy for chronic immune thrombocytopenia. Int J Hematol. 2013;97(5):610–6.CrossRef Wang M, Zhang M, Zhou J, Wu Z, Zeng K, Peng B, Niu T. Predictive factors associated with long-term effects of laparoscopic splenectomy for chronic immune thrombocytopenia. Int J Hematol. 2013;97(5):610–6.CrossRef
13.
go back to reference Aleem A. Durability and factors associated with long term response after splenectomy for primary immune thrombocytopenia (ITP) and outcome of relapsed or refractory patients. Platelets. 2011;22(1):1–7.CrossRef Aleem A. Durability and factors associated with long term response after splenectomy for primary immune thrombocytopenia (ITP) and outcome of relapsed or refractory patients. Platelets. 2011;22(1):1–7.CrossRef
14.
go back to reference Rijcken E, Mees ST, Bisping G, Krueger K, Bruewer M, Senninger N, Mennigen R. Laparoscopic splenectomy for medically refractory immune thrombocytopenia (ITP): a retrospective cohort study on longtime response predicting factors based on consensus criteria. Int J Surg. 2014;12(12):1428–33.CrossRef Rijcken E, Mees ST, Bisping G, Krueger K, Bruewer M, Senninger N, Mennigen R. Laparoscopic splenectomy for medically refractory immune thrombocytopenia (ITP): a retrospective cohort study on longtime response predicting factors based on consensus criteria. Int J Surg. 2014;12(12):1428–33.CrossRef
15.
go back to reference Kim DJ, Chung JH. Long-term results of laparoscopic splenectomy in pediatric chronic immune thrombocytopenic purpura. Ann Surg Treat Res. 2014;86(6):314–8.CrossRef Kim DJ, Chung JH. Long-term results of laparoscopic splenectomy in pediatric chronic immune thrombocytopenic purpura. Ann Surg Treat Res. 2014;86(6):314–8.CrossRef
16.
go back to reference Keidar A, Sagi B, Szold A. Laparoscopic splenectomy for immune thrombocytopenic purpura in patients with severe refractory thrombocytopenia. Pathophysiol Haemost Thromb. 2003;33(2):116–9.CrossRef Keidar A, Sagi B, Szold A. Laparoscopic splenectomy for immune thrombocytopenic purpura in patients with severe refractory thrombocytopenia. Pathophysiol Haemost Thromb. 2003;33(2):116–9.CrossRef
17.
go back to reference Zheng CX, Zheng D, Chen LH, Yu JF. Wu ZM: laparoscopic splenectomy for immune thrombocytopenic purpura at a teaching institution. Chin Med J. 2011;124(8):1175–80.PubMed Zheng CX, Zheng D, Chen LH, Yu JF. Wu ZM: laparoscopic splenectomy for immune thrombocytopenic purpura at a teaching institution. Chin Med J. 2011;124(8):1175–80.PubMed
18.
go back to reference Thachil J. Alternate considerations for current concepts in ITP. Hematology. 2014;19(3):163–8.CrossRef Thachil J. Alternate considerations for current concepts in ITP. Hematology. 2014;19(3):163–8.CrossRef
19.
go back to reference McMillan R. The pathogenesis of chronic immune (idiopathic) thrombocytopenic purpura. Semin Hematol. 2000;37(1 Suppl 1):5–9.CrossRef McMillan R. The pathogenesis of chronic immune (idiopathic) thrombocytopenic purpura. Semin Hematol. 2000;37(1 Suppl 1):5–9.CrossRef
20.
go back to reference Mahevas M, Patin P, Huetz F, Descatoire M, Cagnard N, Bole-Feysot C, Le Gallou S, Khellaf M, Fain O, Boutboul D, et al. B cell depletion in immune thrombocytopenia reveals splenic long-lived plasma cells. J Clin Invest. 2013;123(1):432–42.CrossRef Mahevas M, Patin P, Huetz F, Descatoire M, Cagnard N, Bole-Feysot C, Le Gallou S, Khellaf M, Fain O, Boutboul D, et al. B cell depletion in immune thrombocytopenia reveals splenic long-lived plasma cells. J Clin Invest. 2013;123(1):432–42.CrossRef
21.
go back to reference Duperier T, Brody F, Felsher J, Walsh RM, Rosen M, Ponsky J. Predictive factors for successful laparoscopic splenectomy in patients with immune thrombocytopenic purpura. Arch Surg. 2004;139(1):61–6.CrossRef Duperier T, Brody F, Felsher J, Walsh RM, Rosen M, Ponsky J. Predictive factors for successful laparoscopic splenectomy in patients with immune thrombocytopenic purpura. Arch Surg. 2004;139(1):61–6.CrossRef
22.
go back to reference Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, Chong BH, Cines DB, Gernsheimer TB, Godeau B, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115(2):168–86.CrossRef Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, Chong BH, Cines DB, Gernsheimer TB, Godeau B, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115(2):168–86.CrossRef
23.
go back to reference Khodadi E, Asnafi AA, Shahrabi S, Shahjahani M, Saki N. Bone marrow niche in immune thrombocytopenia: a focus on megakaryopoiesis. Ann Hematol. 2016;95(11):1765–76.CrossRef Khodadi E, Asnafi AA, Shahrabi S, Shahjahani M, Saki N. Bone marrow niche in immune thrombocytopenia: a focus on megakaryopoiesis. Ann Hematol. 2016;95(11):1765–76.CrossRef
24.
go back to reference Arnold DM, Nazi I, Toltl LJ, Ross C, Ivetic N, Smith JW, Liu Y, Kelton JG. Antibody binding to megakaryocytes in vivo in patients with immune thrombocytopenia. Eur J Haematol. 2015;95(6):532–7.CrossRef Arnold DM, Nazi I, Toltl LJ, Ross C, Ivetic N, Smith JW, Liu Y, Kelton JG. Antibody binding to megakaryocytes in vivo in patients with immune thrombocytopenia. Eur J Haematol. 2015;95(6):532–7.CrossRef
25.
go back to reference Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot JF, Leandros E, Lechner K, Rhodes M, Silecchia G, Szold A, et al. Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2008;22(4):821–48.CrossRef Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot JF, Leandros E, Lechner K, Rhodes M, Silecchia G, Szold A, et al. Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2008;22(4):821–48.CrossRef
26.
go back to reference Estcourt LJ, Birchall J, Allard S, Bassey SJ, Hersey P, Kerr JP, Mumford AD, Stanworth SJ, Tinegate H. Guidelines for the use of platelet transfusions. Br J Haematol. 2017;176(3):365–94.CrossRef Estcourt LJ, Birchall J, Allard S, Bassey SJ, Hersey P, Kerr JP, Mumford AD, Stanworth SJ, Tinegate H. Guidelines for the use of platelet transfusions. Br J Haematol. 2017;176(3):365–94.CrossRef
27.
go back to reference Zychowicz A, Radkowiak D, Lasek A, Malczak P, Witowski J, Major P, Strzalka M, Kulawik J, Budzynski A, Pedziwiatr M. Laparoscopic splenectomy for immune thrombocytopenia in patients with a very low platelet count. Wideochir Inne Tech Maloinwazyjne. 2018;13(2):157–63.PubMedPubMedCentral Zychowicz A, Radkowiak D, Lasek A, Malczak P, Witowski J, Major P, Strzalka M, Kulawik J, Budzynski A, Pedziwiatr M. Laparoscopic splenectomy for immune thrombocytopenia in patients with a very low platelet count. Wideochir Inne Tech Maloinwazyjne. 2018;13(2):157–63.PubMedPubMedCentral
28.
go back to reference Patel NY, Chilsen AM, Mathiason MA, Kallies KJ, Bottner WA. Outcomes and complications after splenectomy for hematologic disorders. Am J Surg. 2012;204(6):1014–9.CrossRef Patel NY, Chilsen AM, Mathiason MA, Kallies KJ, Bottner WA. Outcomes and complications after splenectomy for hematologic disorders. Am J Surg. 2012;204(6):1014–9.CrossRef
Metadata
Title
Platelet count on preoperative day 1 predicts the long-term responses to laparoscopic splenectomy for Chinese patients with medically refractory idiopathic thrombocytopenic purpura
Authors
Rui Liao
Pei-Yuan Tang
Jun-Feng Song
Ke-Le Qin
Xun Wang
Xiong Yan
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2018
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-018-0446-8

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