Predictive Factors for Success of Laparoscopic Splenectomy for ITP

Áron Nyilas, Attila Paszt, Bernadett Borda, Zsolt Simonka, Szabolcs Ábrahám, Ágnes Bereczki, Dóra Földeák, G. Lazar

Research output: Contribution to journalArticle

Abstract

Background and Objectives: Therapy-resistant immune thrombocytopenia (ITP) is the most frequent indication of laparoscopic splenectomy (LS). It ensures the best results for this disease compared with possible second-line pharmacologic therapies. Therefore, learning about the safety of the surgical method and its long-term efficacy is important, as is selecting patients who respond to surgical treatment. Our purpose was to analyze the safety of LS and the short-and long-term prognostic significance of known perioperative parameters. Methods: We performed 40 LSs for ITP from January 1, 2000, to January 1, 2015. We analyzed the roles of the perioperative parameters by using evidence-based guidelines. Results: Complete response (CR; platelet count over 100 × 109/L) occurred in 28 cases (70%) and partial response (PR; platelet count between 30 and 100 × 109/L) in 5 cases (12.5%). Below the age of 50, 9% (2/22) of the patients had no response (NR; platelet count not increasing over 30 × 109/L), 28% (5/18) over the age of 50 (P = .023) had no response. In the steroid-refractory group, 30% did not respond, whereas 100% of the steroid-dependent patients had a CR (NR: 7/23 steroid refractory vs 0/17 steroid dependent; P = .027). The patients were followed up for a mean of 10.9 ± 6.9 years, and a long-term response (LTR) was detected in 21 of the responders (n = 33). Of the patients who originally had a CR, 71% also achieved LTR, whereas only 20% of the PR patients did. Conclusion: LS is safe and remains the most effective second-line treatment for ITP. In our study, younger age and response to preoperative steroids were predictive factors for the long-term success of splenectomy.

Original languageEnglish
JournalJSLS : Journal of the Society of Laparoendoscopic Surgeons
Volume22
Issue number4
DOIs
Publication statusPublished - Oct 1 2018

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Idiopathic Thrombocytopenic Purpura
Splenectomy
Steroids
Platelet Count
Safety
Therapeutics
Learning
Guidelines

Keywords

  • Haematological outcome
  • Immune thrombocytopenia
  • Laparoscopic splenectomy
  • Long-term results
  • Response-predictive factors

ASJC Scopus subject areas

  • Surgery

Cite this

Predictive Factors for Success of Laparoscopic Splenectomy for ITP. / Nyilas, Áron; Paszt, Attila; Borda, Bernadett; Simonka, Zsolt; Ábrahám, Szabolcs; Bereczki, Ágnes; Földeák, Dóra; Lazar, G.

In: JSLS : Journal of the Society of Laparoendoscopic Surgeons, Vol. 22, No. 4, 01.10.2018.

Research output: Contribution to journalArticle

Nyilas, Áron ; Paszt, Attila ; Borda, Bernadett ; Simonka, Zsolt ; Ábrahám, Szabolcs ; Bereczki, Ágnes ; Földeák, Dóra ; Lazar, G. / Predictive Factors for Success of Laparoscopic Splenectomy for ITP. In: JSLS : Journal of the Society of Laparoendoscopic Surgeons. 2018 ; Vol. 22, No. 4.
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abstract = "Background and Objectives: Therapy-resistant immune thrombocytopenia (ITP) is the most frequent indication of laparoscopic splenectomy (LS). It ensures the best results for this disease compared with possible second-line pharmacologic therapies. Therefore, learning about the safety of the surgical method and its long-term efficacy is important, as is selecting patients who respond to surgical treatment. Our purpose was to analyze the safety of LS and the short-and long-term prognostic significance of known perioperative parameters. Methods: We performed 40 LSs for ITP from January 1, 2000, to January 1, 2015. We analyzed the roles of the perioperative parameters by using evidence-based guidelines. Results: Complete response (CR; platelet count over 100 × 109/L) occurred in 28 cases (70{\%}) and partial response (PR; platelet count between 30 and 100 × 109/L) in 5 cases (12.5{\%}). Below the age of 50, 9{\%} (2/22) of the patients had no response (NR; platelet count not increasing over 30 × 109/L), 28{\%} (5/18) over the age of 50 (P = .023) had no response. In the steroid-refractory group, 30{\%} did not respond, whereas 100{\%} of the steroid-dependent patients had a CR (NR: 7/23 steroid refractory vs 0/17 steroid dependent; P = .027). The patients were followed up for a mean of 10.9 ± 6.9 years, and a long-term response (LTR) was detected in 21 of the responders (n = 33). Of the patients who originally had a CR, 71{\%} also achieved LTR, whereas only 20{\%} of the PR patients did. Conclusion: LS is safe and remains the most effective second-line treatment for ITP. In our study, younger age and response to preoperative steroids were predictive factors for the long-term success of splenectomy.",
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AU - Nyilas, Áron

AU - Paszt, Attila

AU - Borda, Bernadett

AU - Simonka, Zsolt

AU - Ábrahám, Szabolcs

AU - Bereczki, Ágnes

AU - Földeák, Dóra

AU - Lazar, G.

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N2 - Background and Objectives: Therapy-resistant immune thrombocytopenia (ITP) is the most frequent indication of laparoscopic splenectomy (LS). It ensures the best results for this disease compared with possible second-line pharmacologic therapies. Therefore, learning about the safety of the surgical method and its long-term efficacy is important, as is selecting patients who respond to surgical treatment. Our purpose was to analyze the safety of LS and the short-and long-term prognostic significance of known perioperative parameters. Methods: We performed 40 LSs for ITP from January 1, 2000, to January 1, 2015. We analyzed the roles of the perioperative parameters by using evidence-based guidelines. Results: Complete response (CR; platelet count over 100 × 109/L) occurred in 28 cases (70%) and partial response (PR; platelet count between 30 and 100 × 109/L) in 5 cases (12.5%). Below the age of 50, 9% (2/22) of the patients had no response (NR; platelet count not increasing over 30 × 109/L), 28% (5/18) over the age of 50 (P = .023) had no response. In the steroid-refractory group, 30% did not respond, whereas 100% of the steroid-dependent patients had a CR (NR: 7/23 steroid refractory vs 0/17 steroid dependent; P = .027). The patients were followed up for a mean of 10.9 ± 6.9 years, and a long-term response (LTR) was detected in 21 of the responders (n = 33). Of the patients who originally had a CR, 71% also achieved LTR, whereas only 20% of the PR patients did. Conclusion: LS is safe and remains the most effective second-line treatment for ITP. In our study, younger age and response to preoperative steroids were predictive factors for the long-term success of splenectomy.

AB - Background and Objectives: Therapy-resistant immune thrombocytopenia (ITP) is the most frequent indication of laparoscopic splenectomy (LS). It ensures the best results for this disease compared with possible second-line pharmacologic therapies. Therefore, learning about the safety of the surgical method and its long-term efficacy is important, as is selecting patients who respond to surgical treatment. Our purpose was to analyze the safety of LS and the short-and long-term prognostic significance of known perioperative parameters. Methods: We performed 40 LSs for ITP from January 1, 2000, to January 1, 2015. We analyzed the roles of the perioperative parameters by using evidence-based guidelines. Results: Complete response (CR; platelet count over 100 × 109/L) occurred in 28 cases (70%) and partial response (PR; platelet count between 30 and 100 × 109/L) in 5 cases (12.5%). Below the age of 50, 9% (2/22) of the patients had no response (NR; platelet count not increasing over 30 × 109/L), 28% (5/18) over the age of 50 (P = .023) had no response. In the steroid-refractory group, 30% did not respond, whereas 100% of the steroid-dependent patients had a CR (NR: 7/23 steroid refractory vs 0/17 steroid dependent; P = .027). The patients were followed up for a mean of 10.9 ± 6.9 years, and a long-term response (LTR) was detected in 21 of the responders (n = 33). Of the patients who originally had a CR, 71% also achieved LTR, whereas only 20% of the PR patients did. Conclusion: LS is safe and remains the most effective second-line treatment for ITP. In our study, younger age and response to preoperative steroids were predictive factors for the long-term success of splenectomy.

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KW - Long-term results

KW - Response-predictive factors

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