Abstract | BACKGROUND: Laparoscopic splenectomy (LS) offers better short-term results than open surgery for the treatment of immune thrombocytopenic purpura ( ITP), but long-term follow-up is required to ensure its efficacy. The remission rate after splenectomy ranges from 49 to 86% and the factors that predict a successful response to surgical management have not been clearly defined. The goal of this study was to determine the preoperative factors that predict a successful outcome following LS. METHODS: From February 1993 to December 2003, LS was consecutively performed in a series of 119 nonselected patients diagnosed with ITP (34 men and 85 women; mean age, 41 years), and clinical results were prospectively recorded. Postoperative follow-up was based on clinical records, follow-up data provided by the referring hematologist, and a phone interview with the patient and/or relative. Univariate and multivariate analyses were performed for clinical preoperative variables to identify predictive factors of success following LS. RESULTS: Over a mean period of 33 months, 103 patients (84%) were available for follow-up with a remission rate of 89% (92 patients, 77 with complete remission with platelet count > 150,000). Eleven patients did not respond to surgery (platelet count < 50,000). Mortality during follow-up was 2.5% (two cases not related to hematological pathology and one case without response to splenectomy). Preoperative clinical variables evaluated to identify predictive factors of response to surgery were sex, age, treatment ( corticoids alone or associated with Ig or chemotherapy), other immune pathology, duration of disease, and preoperative platelet count. In a subgroup of 52 patients, we also evaluated the type of autoantibodies and corticoid doses required to maintain a platelet count > 50,000. Multivariate analysis showed that none of the variables evaluated could be considered as predictive factors of response to LS due to the high standard error. CONCLUSION: Long-term clinical results show that LS is a safe and effective therapy for ITP. However, a higher number of nonresponders is needed to determine which variables predict response to LS for ITP.
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Authors | C Balagué, S Vela, E M Targarona, I J Gich, E Muñiz, A D'Ambra, A Pey, V Monllau, E Ascaso, C Martinez, J Garriga, M Trias |
Journal | Surgical endoscopy
(Surg Endosc)
Vol. 20
Issue 8
Pg. 1208-13
(Aug 2006)
ISSN: 1432-2218 [Electronic] Germany |
PMID | 16865623
(Publication Type: Journal Article)
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Topics |
- Adolescent
- Adult
- Aged
- Female
- Humans
- Immune System Diseases
(blood, mortality, surgery)
- Laparoscopy
- Male
- Middle Aged
- Multivariate Analysis
- Platelet Count
- Prognosis
- Prospective Studies
- Purpura, Thrombocytopenic
(blood, mortality, surgery)
- Remission Induction
- Splenectomy
- Treatment Outcome
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