Abstract
Background and Objectives: Laparoscopic splenectomy (LS) has become the gold standard for patients with immune thrombocytopenic purpura (ITP). The total remission rate after splenectomy is 70%–90%, of which 66% is long-term. Despite this high response rate, some patients do not benefit from surgery. It is therefore important to try to identify risk factors for an unsatisfactory clinical response. The aim of this study was to assess long-term outcomes of LS for ITP and identify factors associated with increased disease remission rates. Materials and Methods: We retrospectively studied consecutive patients with ITP undergoing LS in a tertiary referral surgical center prospectively recorded in a database. Inclusion criteria were: Elective, laparoscopic splenectomy for diagnosed ITP, and complete follow-up. The cohort was divided into two groups—Group 1 (G1) patients with ITP remission after splenectomy and Group 2 (G2) patients without remission. There were 113 G1 patients and 52 G2 patients. Median follow-up was 9.5 (IQR: 5–15) years. Results: In univariate analysis, patient’s age, body mass index (BMI), preoperative platelet count, the need for platelet transfusions, and presence of hemorrhagic diathesis were shown to be statistically significant factors. Next, we built a multivariate logistic regression model using factors significant in univariate analysis. Age <41 years (odds ratio (OR) 4.49; 95% CI: 1.66–12.09), BMI < 24.3 kg/m2 (OR: 4.67; 95% CI: 1.44–15.16), and preoperative platelet count ≥97 × 103/mm3 (OR: 3.50; 95% CI: 1.30–9.47) were shown to be independent prognostic factors for ITP remission after LS. Conclusions: The independent prognostic factors for ITP remission after LS revealed in our study are: age <41 years, BMI < 2 4.3 kg/m2, and preoperative platelet count ≥97 × 103/mm3. Duration of the ITP and the time of treatment are not related to remission after LS.
Highlights
Im m u n e th rom b o cy to p en ic p u rp u ra (ITP) is a h em ato lo g ical d iso rd er ch aracterized by au to im m u n e-m ed iated d estru ctio n o f platelets an d red u ctio n o f p latelet prod u ction
A lthough the choice of surgical approach in case of splenectom y is straig h tforw ard d u e to the o bv io u s b en efits o f m in im ally in v asiv e surgery, th e d ecisio nabout sp len ecto m y tim in g itself is still d ifficu lt [7,8,9]
T he reason is th at d esp ite the h ig h resp o n se rate of splenectom y, som e patients do not benefit from surgery
Summary
A nna K w iatkow ska 1, D orota R ad k ow iak 1, M ichał W ysocki -1,2, G rzegorz Torbicz 1,. D esp ite this h ig h resp on se rate, som e p atients do n o t ben efit from surgery It is th erefore im p o rtan t to try to id en tify risk factors for a n u n satisfacto ry clin ical response. T he aim of this stu d y w as to assess long-term outcom es of L S for ITP and id entify factors associated w ith increased disease rem ission rates. C on clu sion s: T h e in d ep en d en t p ro g n ostic factors for ITP rem ission after LS revealed in our study are: age 97 X 103/m m 3. K eyw ords: sp len ecto m y ; IT P ; im m u n e th rom b o cy to p en ia; lap aro sco p y ; rem issio n ; lon g -term outcom es
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