Prognostic factors of response to laparoscopic splenectomy in patients with idiopathic thrombocytopenic purpura.
Laparoscopic splenectomy (LS) has become the treatment of choice for patients with idiopathic thrombocytopenic purpura (ITP) who do not respond to medical treatment. The aim of this study was to identify factors predictive of outcome after LS for ITP. From May 1997 to December 2002, we performed 30 LS on patients with ITP. A positive response was defined as a postoperative platelet count greater than 50,000/micro L and no requirement for maintenance therapy. Chi-square testing was performed to determine the predictive effects of the following variables: age, sex, preoperative response to steroids or immunoglobulin, duration of disease, antiplatelet antibody, platelet associated antibody, and antinuclear antibody. LS was successfully performed in all patients. For a mean follow-up interval of 24.3 months, response to LS was 73.3%. Splenectomy for steroid nonresponders resulted in an inferior complete response rate (10 of 18, 55.6%) as compared with those that experienced relapse after steroid treatment (11 of 12, 91.7%) (p=0.042). The other significant predictor of outcome by univariate analysis was the time between diagnosis and surgery (p=0.049). The other variables showed no significant correlation with successful splenectomy. We conclude that LS can be performed safely with a satisfactory remission rate in patients with ITP who do not respond to medical treatment, and that the factors most frequently associated with surgical success are a response to steroid and disease duration.
Kwon
Hyuk-Chan
HC
Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea.
Moon
Chang-Hoon
CH
Cho
Young-Rak
YR
Kim
Min-Chan
MC
Kim
Kyeong-Hee
KH
Han
Jin-Yeong
JY
Lee
Young-Ho
YH
Oh
Sung-Yong
SY
Kim
Sung-Hyun
SH
Kim
Jae-Seok
JS
Kim
Hyo-Jin
HJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome