Predictive factors for successful laparoscopic splenectomy in patients with immune thrombocytopenic purpura.

Abstract

Younger patients with immune thrombocytopenic purpura (ITP) and high preoperative platelet counts successfully respond to laparoscopic splenectomy (LS). Case series. Private, tertiary care referral center. Sixty-seven consecutive patients undergoing LS for ITP between 1995 and 2001. Laparoscopic splenectomy. A successful response to LS was defined as a postoperative platelet count greater than 100 x 10(3)/microL without medical therapy. Failures were classified as recurrent or refractory. Patients considered refractory to surgery did not achieve a platelet count greater than 100 x 10(3)/microL without medical therapy. Patients with recurrent ITP initially achieved a platelet count greater than 100 x 10(3)/microL, but thrombocytopenia subsequently recurred. Both univariate and multivariate analyses were performed for 13 preoperative variables to identify factors predictive of success following LS. At a mean follow up of 22 months, 43 patients (64%) had a successful response to LS, 14 (21%) were refractory, and 10 (15%) developed recurrent ITP. By univariate analysis, patients responding to laparoscopic splenectomy were younger (P =.005) and had a higher preoperative platelet count (P =.005). In multivariate analysis, younger age (P =.005) and a higher preoperative platelet count (P =.007) again predicted a successful response to LS. A successful response to LS for ITP is expected in patients younger than 50 years and in those with preoperative platelet counts greater than 70 x 10(3)/microL. These factors can be incorporated into an equation that yields a splenectomy prediction score, which predicts the success of LS for ITP.