Value of splenectomy in treating autoimmune hematological diseases

Abstract

Objective To investigate the application value of splenectomy in the treatment of autoimmune hematological diseases. Methods Clinical data of 85 patients with autoimmune hematological diseases who underwent splenectomy in Peking University People's Hospital from January 2003 to January 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 26 patients were male and 59 female, aged 18-71 yearswith a median age of 39 years. 69 patients were diagnosed with primary immune thrombocytopenia (ITP), 12 with autoimmune hemolytic anemia (AHA) and 4 with Evans syndrome. The first-line treatment of glucocorticoid or gamma globulin in some patients failed, and some were hormone intolerant or disease recurred. The patients were divided into the open splenectomy group (n=55) and laparoscopic splenectomy group (n=30) according to different surgical procedure. Routine blood tests were conducted after operation at regular intervals. Postoperative complications and clinical efficacy were closely observed. The length of hospital stay was statistically compared between two groups by unpaired t test. The rate comparison was performed by Chi-square test. Results The incidence of postoperative complications in the laparoscopic splenectomy group was 13%(4/30), where no significant difference was observed from 18%(10/55) in the open splenectomy group (χ2=0.76, P>0.05). In the laparoscopic splenectomy group, the average length of hospital stay was (5.3±0.7) d, significantly shorter than (7.0±1.6) d in the open splenectomy group (t=-2.87, P<0.05). The 1- and 5-year complete remission rates were 78%(54/69) and 61%(42/69) for ITP patients, 83%(10/12) and 58%(7/12) for AHA patients, and 4/4 and 2/4 for Evans syndrome patients, respectively. Conclusions Splenectomy is a reliable and effective second-line treatment for autoimmune hematological diseases. Laparoscopic splenectomy is as safe and effective as open splenectomy, whereas it is minimally invasive and accelerates the postoperative recovery Key words: Splenectomy; Thrombocytopenia; Anemia, hemolytic, autoimmune