title: Role of Laparoscopic Splenectomy in Elderly Immune Thrombocytopenia.
abstract: The management of older patients with chronic primary immune thrombocytopenia (ITP) is still very challenging because of the fragility of older patients who frequently have severe comorbidities and/or disabilities. Corticosteroid-based first-line therapies fail in most of the cases and patients require a second-line treatment, choosing between rituximab, thrombopoietin-receptor agonists and splenectomy. The choice of the best treatment in elderly patients is a compromise between effectiveness and safety and laparoscopic splenectomy may be a good option with a complete remission rate of 67% at 60 months. But relapse and complication rates remain higher than in younger splenectomized ITP patients because elderly patients undergo splenectomy with unfavorable conditions (age >60 year-old, presence of comorbidities, or multiple previous treatments) which negatively influence the outcome, regardless the hematological response. For these reasons, a good management of concomitant diseases and the option to not use the splenectomy as the last possible treatment could improve the outcome of old splenectomized patients.
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Giudice
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Rosamilio
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.
authors.forename: Bianca
authors.initials: B
authors.lastname: Serio
authors.affiliation: Division of Pathology Second University of Naples, Naples, Italy.
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Di Crescenzo
authors.affiliation: Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Rossi
authors.affiliation: Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Amato
authors.initials: A
authors.lastname: De Paulis
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pilone
authors.affiliation: Hematology and Transplant Center, Department of Medicine and Surgery, University of Salerno, Salerno, 84131, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Selleri
keywords: Elderly; Immune thrombocytopenia; Laparoscopy; Splenectomy