title: Laparoscopic splenectomy for medically refractory immune thrombocytopenia (ITP): a retrospective cohort study on longtime response predicting factors based on consensus criteria.
abstract: BACKGROUND
  Laparoscopic splenectomy has been proposed to be the standard therapy for adult patients with medically refractory immune thrombocytopenia (ITP). However, due to inconsistent definitions of response, variable rates of long term response have been reported. Furthermore, new medical treatment options are currently challenging the role of splenectomy. The aims of this study were to (1) analyze long term response after splenectomy according to recently defined consensus criteria, (2) identify possible predictive response factors.
  
  
  METHODS
  A case series of 72 consecutive patients with ITP undergoing laparoscopic splenectomy was retrospectively studied using univariate and multivariate analysis as well as logrank tests.
  
  
  RESULTS
  Median follow-up was 32 (2-110) months. Mortality was 0% and morbidity was 8.2%. Response to splenectomy was achieved in of 63/72 patients (87.5%). Loss of response occurred in 19/63 (30.2%) in median after 3 (range 2-42) months. Preoperative platelet counts after boosting with steroids and immunoglobulins as well as the postoperative rise in platelet counts were statistically significant factors for response upon both univariate and multivariate analysis, whereas age, gender, body mass index, ASA classification, disease duration, accessory spleens, splenic weight, conversion to open surgery, or perioperative complications were not. Patients with a postoperative rise in platelet counts >150,000/μL had a significant better chance on stable long term response than those with a smaller increment (P < 0.001).
  
  
  CONCLUSIONS
  Laparoscopic splenectomy is an effective and safe treatment option in order to obtain stable long term response in patients with ITP. Perioperative platelet counts are predictive factors of long term response.
authors.affiliation: Department of General and Visceral Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, Building W1, D-48149 Muenster, Germany. Electronic address: rijcken@uni-muenster.de.
authors.forename: Emile
authors.initials: E
authors.lastname: Rijcken
authors.affiliation: Department of General and Visceral Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, Building W1, D-48149 Muenster, Germany.
authors.forename: Soeren Torge
authors.initials: ST
authors.lastname: Mees
authors.affiliation: Mathias Spital Rheine, Frankenburgstr. 31, D-48431 Rheine, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Bisping
authors.affiliation: Department of General and Visceral Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, Building W1, D-48149 Muenster, Germany.
authors.forename: Kristin
authors.initials: K
authors.lastname: Krueger
authors.affiliation: St. Franziskus Hospital Muenster, Hohenzollernring 72, D-48145 Muenster, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bruewer
authors.affiliation: Department of General and Visceral Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, Building W1, D-48149 Muenster, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
authors.affiliation: Department of General and Visceral Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, Building W1, D-48149 Muenster, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Mennigen
mesh_terms: D000704:Analysis of Variance; D015331:Cohort Studies; D032921:Consensus; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D016014:Linear Models; D008297:Male; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000601:surgery*; D012189:Retrospective Studies; D013154:Spleen / Q000601:surgery; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: ITP; Immune thrombocytopenia; Laparoscopic splenectomy; Long term response; Response prediction