Predictive factors for successful laparoscopic splenectomy in immune thrombocytopenic purpura: study of clinical and laboratory data.
BACKGROUND
Laparoscopic splenectomy (LS) offers better short-term results than open surgery for the treatment of immune thrombocytopenic purpura (ITP), but long-term follow-up is required to ensure its efficacy. The remission rate after splenectomy ranges from 49 to 86% and the factors that predict a successful response to surgical management have not been clearly defined. The goal of this study was to determine the preoperative factors that predict a successful outcome following LS.


METHODS
From February 1993 to December 2003, LS was consecutively performed in a series of 119 nonselected patients diagnosed with ITP (34 men and 85 women; mean age, 41 years), and clinical results were prospectively recorded. Postoperative follow-up was based on clinical records, follow-up data provided by the referring hematologist, and a phone interview with the patient and/or relative. Univariate and multivariate analyses were performed for clinical preoperative variables to identify predictive factors of success following LS.


RESULTS
Over a mean period of 33 months, 103 patients (84%) were available for follow-up with a remission rate of 89% (92 patients, 77 with complete remission with platelet count > 150,000). Eleven patients did not respond to surgery (platelet count < 50,000). Mortality during follow-up was 2.5% (two cases not related to hematological pathology and one case without response to splenectomy). Preoperative clinical variables evaluated to identify predictive factors of response to surgery were sex, age, treatment (corticoids alone or associated with Ig or chemotherapy), other immune pathology, duration of disease, and preoperative platelet count. In a subgroup of 52 patients, we also evaluated the type of autoantibodies and corticoid doses required to maintain a platelet count > 50,000. Multivariate analysis showed that none of the variables evaluated could be considered as predictive factors of response to LS due to the high standard error.


CONCLUSIONS
Long-term clinical results show that LS is a safe and effective therapy for ITP. However, a higher number of nonresponders is needed to determine which variables predict response to LS for ITP.
Balagué
C
C
Service of Surgery, Hospital de Sant Pau, C/Padre Claret 167, 08025, Barcelona, Spain, cbalague@hsp.santpau.es
Vela
S
S
Targarona
E M
EM
Gich
I J
IJ
Muñiz
E
E
D'Ambra
A
A
Pey
A
A
Monllau
V
V
Ascaso
E
E
Martinez
C
C
Garriga
J
J
Trias
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007154:Immune System Diseases / Q000097:blood / Q000401:mortality / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010976:Platelet Count; D011379:Prognosis; D011446:Prospective Studies; D011696:Purpura, Thrombocytopenic / Q000097:blood / Q000401:mortality / Q000601:surgery*; D012074:Remission Induction; D013156:Splenectomy; D016896:Treatment Outcome