Splenectomy versus medical treatment for idiopathic thrombocytopenic purpura.
BACKGROUND
Treatment strategies for idiopathic thrombocytopenic purpura (ITP) are still uncertain and its management is primarily empirical. The aim of this study was to investigate the role of splenectomy in the therapy of ITP and to evaluate whether medical or surgical treatment is superior.


METHODS
Ninety-two patients with ITP were included in the study. All of these patients had medical therapy and 38 of them underwent splenectomy subsequently. Follow-up was completed in 91 patients after a median of 64 months.


RESULTS
Side effects of medical therapy were noticed in 32 patients (35%), whereas after surgery only 2 patients (5%) had minor complications. A complete or partial remission was achieved in 35 patients (92%) after splenectomy, whereas this was achieved in only 27 patients (30%) after medical therapy. On multivariate analysis splenectomy and age were the only significant independent factors for complete and partial remission.


CONCLUSIONS
Splenectomy is highly effective and safe in the treatment of ITP and is superior over medical therapy. These results should stimulate the discussion about splenectomy for ITP, possibly establishing evidence-based guidelines for surgical treatment in hematology.
Gadenstätter
Michael
M
Department of Surgery, University of Innsbruck, Anichstrasse 35, Austria. michael.gadenstaetter@uibk.ac.at
Lamprecht
Bernd
B
Klingler
Anton
A
Wetscher
Gerold J
GJ
Greil
Richard
R
Schmid
Thomas
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006401:Hematologic Agents / Q000627:therapeutic use*; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy* / Q000601:surgery*; D012074:Remission Induction; D013156:Splenectomy; D016896:Treatment Outcome; D014747:Vinblastine / Q000627:therapeutic use
D000972:Antineoplastic Agents, Phytogenic; D005938:Glucocorticoids; D006401:Hematologic Agents; D007136:Immunoglobulins; D014747:Vinblastine