Abstract
BackgroundLaparoscopic 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.MethodsFrom 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.ResultsUnivariate 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.ConclusionsLS 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.
Highlights
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
Platelet count on preoperative day (PRD) 1 is an independent predicting factor for long-term response after LS for Chinese patients with ITP
The including criteria were (1) ITP cases diagnosed through bone marrow aspiration, excluding thrombocytopenia or other causes; (2) treatment with corticosteroid and intravenous immunoglobulin that proved to be insignificant, ineffective, or intolerable; (3) operations completed by the same surgical team; and (4) all underwent total laparoscopic splenectomy
Summary
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. Laparoscopic splenectomy (LS) is regarded as a second-line treatment for refractory ITP or the unacceptable medication toxicity, Of note, splenectomy renders patients vulnerable to opportunistic infection such as life-threatening, overwhelming post-splenectomy infection [7]. Numerous clinical studies on the predictive factors such as age, [9] disease course, [10] accessory spleen removal, [11] platelet counts, [12, 13] response to steroids, [13] and so on have been published, but results are still a matter of debate among surgeons because of a lack of consensus
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