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Sharon CE, Straker RJ, Perry N, Miura JT, Karakousis GC. Postsplenectomy morbidity and mortality in patients with immune thrombocytopenic purpura: A national cohort study. J Surg Oncol 2022; 126:718-727. [PMID: 35712894 DOI: 10.1002/jso.26986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND We sought to identify factors associated with 30-day morbidity, and their impact on 30-day mortality, among patients undergoing splenectomy for immune thrombocytopenic purpura (ITP). METHODS Using the ACS-NSQIP database, patients undergoing splenectomy for ITP were identified (2005-2019), and those with and without postoperative complications within 30 days of surgery were compared. RESULTS Of 2483 patients evaluated, 280 (11.3%) developed 30-day morbidity: infection (n= 145 [5.8%]), venous thromboembolism (n = 71 [2.9%]), acute renal failure (n = 7 [0.3%]), respiratory failure (n = 40 [1.6%]), cardiac arrest/myocardial infarction (n = 16 [0.6%]), cerebrovascular accident (n = 4 [0.2%]), or postoperative blood transfusion (n = 62 [2.5%]). Risk-factors for 30-day morbidity included age ≥50 years (odds ratio [OR] 1.50, p = 0.020), body mass index ≥30 kg/m2 (OR 1.45, p = 0.023), functional dependence (OR 2.90, p = 0.009), preoperative albumin <3.5 g/dL (OR 2.10, p < 0.001), preoperative platelets <30 000/μL (OR 1.54, p = 0.020), open surgical approach (OR 2.32, p < 0.001), and inpatient status before surgery (OR 1.85, p = 0.040). Among patients at low-risk for 30-day morbidity (no risk-factors present), the 30-day morbidity rate was 5.0% versus 41.5% for ≥5 risk-factors (p < 0.001). Thirty-day mortality was 1.2%. CONCLUSIONS Thirty-day morbidity and mortality are low with splenectomy for ITP. Select patients have particularly low perioperative risk and may benefit from early splenectomy if initial medical therapy fails.
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Affiliation(s)
- Cimarron E Sharon
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Richard J Straker
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nikhita Perry
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John T Miura
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Giorgos C Karakousis
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Vianelli N, Auteri G, Buccisano F, Carrai V, Baldacci E, Clissa C, Bartoletti D, Giuffrida G, Magro D, Rivolti E, Esposito D, Podda GM, Palandri F. Refractory primary immune thrombocytopenia (ITP): current clinical challenges and therapeutic perspectives. Ann Hematol 2022; 101:963-978. [PMID: 35201417 PMCID: PMC8867457 DOI: 10.1007/s00277-022-04786-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/01/2022] [Indexed: 01/19/2023]
Abstract
Chronic primary immune thrombocytopenia (ITP) can today benefit from multiple therapeutic approaches with proven clinical efficacy, including rituximab, thrombopoietin receptor agonists (TPO-RA), and splenectomy. However, some ITP patients are unresponsive to multiple lines of therapy with prolonged and severe thrombocytopenia. The diagnosis of refractory ITP is mainly performed by exclusion of other disorders and is based on the clinician's expertise. However, it significantly increases the risk of drug-related toxicity and of bleedings, including life-threatening events. The management of refractory ITP remains a major clinical challenge. Here, we provide an overview of the currently available treatment options, and we discuss the emerging rationale of new therapeutic approaches and their strategic combination. Particularly, combination strategies may target multiple pathogenetic mechanisms and trigger additive or synergistic effects. A series of best practices arising both from published studies and from real-life clinical experience is also included, aiming to optimize the management of refractory ITP.
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Affiliation(s)
- Nicola Vianelli
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli, Bologna, Italy
| | - Giuseppe Auteri
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli, Bologna, Italy.,Dipartimento Di Medicina Specialistica, Diagnostica E Sperimentale, Università Di Bologna, Bologna, Italy
| | - Francesco Buccisano
- Dipartimento Di Biomedicina E Prevenzione, Università Tor Vergata, Rome, Italy
| | | | | | | | - Daniela Bartoletti
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli, Bologna, Italy.,Dipartimento Di Medicina Specialistica, Diagnostica E Sperimentale, Università Di Bologna, Bologna, Italy
| | | | | | - Elena Rivolti
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Daniela Esposito
- Presidio Ospedaliero San G. Moscati Di Aversa - ASL Caserta, Caserta, Italy
| | - Gian Marco Podda
- Medicina III, Ospedale San Paolo, ASST Santi Paolo E Carlo, Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Milano, Italy
| | - Francesca Palandri
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli, Bologna, Italy.
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3
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Péré G, Basselerie H, Maulat C, Pitocco A, Leblanc P, Philis A, Julio CH, Tuyeras G, Buscail E, Carrere N. Splenic volume and splenic vein diameter are independent pre-operative risk factors of portal vein thrombosis after splenectomy: a retrospective cohort study. BMC Surg 2021; 21:366. [PMID: 34641842 PMCID: PMC8513289 DOI: 10.1186/s12893-021-01364-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/23/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Portal vein thrombosis (PVT) is a common complication following splenectomy. It affects between 5 and 55% of patients undergoing surgery with no clearly defined pre-operative risk factors. The aim of this study was to determine the pre-operative risk factors of PVT. PATIENTS AND METHOD Single centre, retrospective study of data compiled for every consecutive patient who underwent splenectomy at Toulouse University Hospital between January 2009 and January 2019. Patients with pre- and post-surgical CT scans have been included. RESULTS 149 out of 261 patients were enrolled in the study (59% were males, mean age 52 years). The indications for splenectomy were splenic trauma (30.9%), malignant haemopathy (26.8%) and immune thrombocytopenia (8.0%). Twenty-nine cases of PVT (19.5%) were diagnosed based on a post-operative CT scan performed on post-operative day (POD) 5. Univariate analysis identifies three main risk factors associated with post-operative PVT: estimated splenic weight exceeding 500 g with an OR of 8.72 95% CI (3.3-22.9), splenic vein diameter over 10 mm with an OR of 4.92 95% CI (2.1-11.8) and lymphoma with an OR of 7.39 (2.7-20.1). The role of splenic vein diameter with an OR of 3.03 95% CI (1.1-8.6), and splenic weight with an OR of 5.22 (1.8-15.2), as independent risk factors is confirmed by multivariate analysis. A screening test based on a POD 5 CT scan with one or two of these items present could indicate sensitivity of 86.2% and specificity of 86.7%. CONCLUSION This study suggests that pre-operative CT scan findings could predict post-operative PVT. A CT scan should be performed on POD 5 if a risk factor has been identified prior to surgery.
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Affiliation(s)
- Guillaume Péré
- Department of Digestive Surgery, Upper Gastro-Intestinal Tract Surgical Unit, University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France.
| | - Hubert Basselerie
- Department of Radiology, University Hospital of Toulouse, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France
| | - Charlotte Maulat
- Department of Digestive Surgery, Upper Gastro-Intestinal Tract Surgical Unit, University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Armando Pitocco
- Unit of Epidemiology, Épidémiologie, Pôle Santé Publique et Médecine Sociale, Faculté de Médecine de Purpan, University of Toulouse III Paul Sabatier, 37 allées Jules Guesde, 31073, Toulouse Cedex, France
| | - Pierrick Leblanc
- Digestive Surgery, Joseph Ducuing Hospital, Hopital Ducuing, 15 rue de Varsovie, 31 300, Toulouse, France
| | - Antoine Philis
- Department of Digestive Surgery, Upper Gastro-Intestinal Tract Surgical Unit, University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Charles Henri Julio
- Department of Digestive Surgery, Upper Gastro-Intestinal Tract Surgical Unit, University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Géraud Tuyeras
- Department of Digestive Surgery, Upper Gastro-Intestinal Tract Surgical Unit, University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Etienne Buscail
- Department of Digestive Surgery, Upper Gastro-Intestinal Tract Surgical Unit, University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
- INSERM 1220, IRSD University of Toulouse Paul Sabatier, CHU Purpan, Place du Docteur Baylac, CS 6003931024, Toulouse cedex 3, France
| | - Nicolas Carrere
- Department of Digestive Surgery, Upper Gastro-Intestinal Tract Surgical Unit, University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
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Uğur MC, Namdaroğlu S, Doğan EE, Turan Erkek E, Nizam N, Eren R, Bilgir O. Comparison of Splenectomy and Eltrombopag Treatment in the Second-Line Treatment of Immune Thrombocytopenic Purpura. Turk J Haematol 2021; 38:181-187. [PMID: 34162173 PMCID: PMC8386313 DOI: 10.4274/tjh.galenos.2021.2021.0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: Primary immune thrombocytopenia (ITP) is an acquired autoimmune disease characterized by isolated thrombocytopenia. While first-line treatments focus on inhibiting autoantibodies and platelet destruction, second- and third-line treatments include splenectomy and thrombopoietin receptor agonists. In this study, we aimed to compare the efficiency and toxicities of splenectomy and eltrombopag as second-line treatments in ITP. Materials and Methods: We retrospectively analyzed patients who were diagnosed with ITP and followed between 2015 and 2020. Patients who underwent splenectomy or received eltrombopag treatment as second-line or further therapy were included. For subgroup analyses, patients were further stratified according to whether they received eltrombopag in the second or third line of treatment. Results: There were 38 patients in the splenectomy group and 47 patients in the eltrombopag group. The mean age of patients in the splenectomy and eltrombopag groups was 43.2 and 50.5 years, respectively. Time to response was significantly shorter in the splenectomy arm (p=0.001). However, response rates at the 3rd, 6th, 12th, and 24th months did not exhibit a statistically significant difference between groups; nor did total duration of response and adverse events. Response rates at the 1st, 3rd, 6th, 12th, and 24th months and the total duration of response did not exhibit a statistically significant difference between eltrombopag subgroups. Eltrombopag treatment was ceased for 20 patients after a median of 54.1 months (range: 1-151). Among them, 12 patients (60%) did not experience a loss of response. Conclusion: Comparing the splenectomy and eltrombopag arms, even though time to achieve response was in favor of the splenectomy group, this advantage disappeared when overall response rates and response rate at the 2nd year were considered. Using eltrombopag in the second or third line of therapy does not yield any difference in terms of time to achieving response.
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Affiliation(s)
- Mehmet Can Uğur
- University of Health Sciences Turkey, İzmir Bozyaka Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
| | - Sinem Namdaroğlu
- University of Health Sciences Turkey, İzmir Bozyaka Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
| | - Esma Evrim Doğan
- University of Health Sciences Turkey, Prof. Dr. Cemil Taşçıoğlu Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Esra Turan Erkek
- University of Health Sciences Turkey, İzmir Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Nihan Nizam
- İzmir Çiğli Training and Research Hospital, Clinic of Internal Medicine, İzmir, Turkey
| | - Rafet Eren
- University of Health Sciences Turkey, İzmir Bozyaka Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
| | - Oktay Bilgir
- University of Health Sciences Turkey, İzmir Bozyaka Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
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5
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Fu X, Yang Z, Tu S, Xin W, Chen H, Li X, Li Y, Xiao W. Short- and long-term outcomes of 486 consecutive laparoscopic splenectomy in a single institution. Medicine (Baltimore) 2021; 100:e25308. [PMID: 33787621 PMCID: PMC8021369 DOI: 10.1097/md.0000000000025308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 03/06/2021] [Indexed: 01/04/2023] Open
Abstract
Since its introduction in 1991, laparoscopic splenectomy (LS) has become the gold standard in elective spleen surgery in many centres. However, there still lack the report of long-term outcomes of LS with the large-scale cases. The aim of the present study was to analyze the short- and long-term outcomes of LS in a single institution over 16 years, and to compare the perioperative outcomes of totally laparoscopic splenectomy (TLS) and hand-assisted laparoscopic splenectomy (HALS) for splenomegaly.Between November 2002 and December 2018, 486 consecutive patients undergoing elective LS were enrolled in this study, including 222 TLS and 264 HALS. The intraoperative, postoperative, and follow-up data were retrospectively analyzed.The 5 most common indications were hypersplenism (71.0%), immune thrombocytopenia (14.8%), splenic benign tumor (4.5%), splenic cyst (2.9%), and splenic malignant tumor (2.9%). The mean operative time, intraoperative blood loss, and length of stay were 149.4 ± 63.3 minutes, 230.1 ± 225.1 mL, and 6.7 ± 3.2 days, respectively. The morbidity, mortality, reoperation, and conversion rate were 23.0%, 0, 0.4%, and 1.9%, respectively. Portal vein system thrombosis (PVST) was the most frequent complication with an incidence of 19.8%. The incidence of PVST in HALS was higher than that in TLS (23.9% vs 14.9%, P = .013). Compared with TLS, HALS had a shorter operative time (P = .000), lower intraoperative blood loss (P = .000), comparable conversion rate (P = .271), and morbidity (P = .922) for splenomegaly > 17.0 cm. During the follow-up period, the overall respond rate for immune thrombocytopenia was 77.8%, and the esophagogastric variceal bleeding rate was 6.9% in 320 patients with hypersplenism secondary to hepatic cirrhosis.LS is a safe, feasible, and effective procedure with satisfactory short- and long-term outcomes. HALS is a reasonable technique in patients with massive spleens.
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Affiliation(s)
| | | | | | | | - Haiming Chen
- Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xueming Li
- Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Li
- Department of General Surgery
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6
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Amini SN, Nelson VS, Sobels A, Schoones JW, Zwaginga JJ, Schipperus MR. Autologous platelet scintigraphy and clinical outcome of splenectomy in immune thrombocytopenia: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 153:103040. [PMID: 32712518 DOI: 10.1016/j.critrevonc.2020.103040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/18/2022] Open
Abstract
Autologous platelet sequestration pattern is associated with post-splenectomy platelet response in patients with immune thrombocytopenia (ITP). However, published results are contradictory, and have not been systematically reviewed. Our aim is to systematically review and meta-analyse the association between sequestration pattern and post-splenectomy platelet response. Articles were selected from MEDLINE when they a) included ITP patients, b) performed scintigraphy, and c) included post-splenectomy platelet response. The 23 included studies (published between 1969-2018) represented 2966 ITP-patients. Response to splenectomy occurred most frequently in patients with a splenic pattern (87.1 % in splenic versus 47.1 % in mixed and 25.5 % in hepatic patterns). A pooled analysis of 8 studies showed an odds ratio of 14.21 (95 % CI: 3.65-55.37) for platelet response in the splenic versus the hepatic group. Our findings indicate that a splenic sequestration pattern is associated with better response after splenectomy. Platelet sequestration patterns may be useful in the clinical decision-making regarding splenectomy.
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Affiliation(s)
- S N Amini
- Department of Hematology, Haga Teaching Hospital, The Hague, the Netherlands; Department of Immune Hematology & Blood Transfusion, Leiden University Medical Centre (LUMC), Leiden, the Netherlands.
| | - V S Nelson
- Department of Hematology, Haga Teaching Hospital, The Hague, the Netherlands; Department of Immune Hematology & Blood Transfusion, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - A Sobels
- Department of Hospital Pharmacy, Haga Teaching Hospital, The Hague, the Netherlands
| | - J W Schoones
- Walaeus Library, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - J J Zwaginga
- Department of Immune Hematology & Blood Transfusion, Leiden University Medical Centre (LUMC), Leiden, the Netherlands; Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - M R Schipperus
- Department of Hematology, Haga Teaching Hospital, The Hague, the Netherlands; Department of Hematology, University Medical Centre Groningen (UMCG), Groningen, the Netherlands
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7
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Cirasino L, Robino AM, Podda G, Andrès E, Despotovic JM, Elalfy M, Holbro A, Kondo T, Lambert MP, Loggetto SR, McCrae KR, Lee JW, Cattaneo M. Report of a 'consensus' on the lines of therapy for primary immune thrombocytopenia in adults, promoted by the Italian Gruppo di Studio delle Piastrine. Platelets 2020; 31:461-473. [PMID: 32314933 DOI: 10.1080/09537104.2020.1751105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Despite the publication in 2009 of a paper on 'terms and definitions of immune thrombocytopenia' (ITP), some unresolved issues remain and are reflected by the disagreement in the treatment suggested for primary ITP in adults. Considering that these disagreements could be ascribed to non-shared goals, we generated a 'consensus' on some terms, definitions, and assertions useful for classifying the different lines of treatment for primary ITP in adults according to their indications and goals. Agreement on the appropriateness of the single assertions was obtained by consensus for the following indicators: 1. classification of four 'lines of therapy'; 2. acceptance of the expression 'sequences of disease' for the indications of the respective four lines of treatment; 3I . practicability of splenectomy; 3Ib . acceptance, with only some exceptions, of a 'timing for elective splenectomy of 12 months'; and 4a-d . 'goals of the four lines of therapy.' On the basis of the consensus, a classification of four lines of treatment for primary ITP in adults was produced. In our opinion, this classification, whose validity is not influenced by the recently published new guidelines of the American Society of Hematology (ASH) and reviews, could reduce the disagreement that still exists regarding the treatment of the disease.
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Affiliation(s)
| | - Anna M Robino
- Medicina B3, Ospedale Niguarda Ca' Granda , Milano, Italy
| | - GianMarco Podda
- Medicina 2 ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano , Milano, Italy
| | - Emmanuel Andrès
- Clinique Médicale B Hôpitaux Universitaires de Strasbourg (HUS) , Strasbourg, France
| | | | - Mohsen Elalfy
- Faculty of Medicine, Ain Shams University Hospitals Cairo , Egypt
| | - Andreas Holbro
- Blood Transfusion Center SRC and Hematology, University Hospital Basel, Swiss Red Cross , Basel, Switzerland
| | - Tadakazu Kondo
- Department of Hematology/Oncology, Graduate School of Medicine, Kyoto University , Kyoto, Japan
| | - Michele P Lambert
- The Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA
| | - Sandra R Loggetto
- Department of Pediatric Hematology, Sabara Pediatric Hospital , Sao Paulo, Brazil
| | - Keith R McCrae
- Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic Lerner College of Medicine , Cleveland, OH, USA
| | - Jong Wook Lee
- Division of Hematology, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea , Seoul, Korea
| | - Marco Cattaneo
- Medicina 2 ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano , Milano, Italy
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8
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Prognostic Factors for Immune Thrombocytopenic Purpura Remission after Laparoscopic Splenectomy: A Cohort Study. ACTA ACUST UNITED AC 2019; 55:medicina55040112. [PMID: 31003557 PMCID: PMC6524013 DOI: 10.3390/medicina55040112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/01/2019] [Accepted: 04/11/2019] [Indexed: 12/19/2022]
Abstract
Background and Objectives: Laparoscopic splenectomy (LS) has become the gold standard for patients with immune thrombocytopenic purpura (ITP). The total remission rate after splenectomy is 70%–90%, of which 66% is long-term. Despite this high response rate, some patients do not benefit from surgery. It is therefore important to try to identify risk factors for an unsatisfactory clinical response. The aim of this study was to assess long-term outcomes of LS for ITP and identify factors associated with increased disease remission rates. Materials and Methods: We retrospectively studied consecutive patients with ITP undergoing LS in a tertiary referral surgical center prospectively recorded in a database. Inclusion criteria were: Elective, laparoscopic splenectomy for diagnosed ITP, and complete follow-up. The cohort was divided into two groups—Group 1 (G1) patients with ITP remission after splenectomy and Group 2 (G2) patients without remission. There were 113 G1 patients and 52 G2 patients. Median follow-up was 9.5 (IQR: 5–15) years. Results: In univariate analysis, patient’s age, body mass index (BMI), preoperative platelet count, the need for platelet transfusions, and presence of hemorrhagic diathesis were shown to be statistically significant factors. Next, we built a multivariate logistic regression model using factors significant in univariate analysis. Age <41 years (odds ratio (OR) 4.49; 95% CI: 1.66–12.09), BMI < 24.3 kg/m2 (OR: 4.67; 95% CI: 1.44–15.16), and preoperative platelet count ≥97 × 103/mm3 (OR: 3.50; 95% CI: 1.30–9.47) were shown to be independent prognostic factors for ITP remission after LS. Conclusions: The independent prognostic factors for ITP remission after LS revealed in our study are: age <41 years, BMI < 2 4.3 kg/m2, and preoperative platelet count ≥97 × 103/mm3. Duration of the ITP and the time of treatment are not related to remission after LS.
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9
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Li SC, Rangel AD, Kabeer MH. Precision Technique for Splenectomy Limits Mouse Stress Responses for Accurate and Realistic Measurements for Investigating Inflammation and Immunity. Bio Protoc 2019; 9:e3317. [PMID: 31497622 DOI: 10.21769/bioprotoc.3317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Splenectomy in an animal model requires a standardized technique utilizing best practice to avoid variability which can result in adverse impact to the animal resulting in flawed physiologic responses simply due to technique rather than to the studied variables. In the case of the spleen, often investigators are analyzing the animal immune or inflammatory responses. Surgical splenectomy involves many variables from the training and expertise of the surgeon, which directly correlates to surgical technique to the length of operation and ease of the procedure. This operation, in turn, impacts blood loss and insensible fluid losses, sterile technique, unintended trauma to the spleen and surrounding organs, the length of the incision and the duration of the operation with more prolonged exposure to anesthetic agents. All these variables ultimately play a significant role in the experiment since they directly affect the response of the model in terms of inflammation, immune activation, or even suppression. Undesired variables such as these go unnoticed and lead to inaccurate and misleading data.
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Affiliation(s)
- Shengwen Calvin Li
- CHOC Children's Research Institute, Neuro-oncology and Stem Cell Research Laboratory (NSCL), Center for Neuroscience Research (CNR), Children's Hospital of Orange County (CHOC), 1201 W. La Veta Ave.; Orange, CA 92868-3874, United States of America.,Department of Neurology, University of California-Irvine School of Medicine, 200 S Manchester Ave Ste 206, Orange, CA 92868, United States of America
| | - Anthony D Rangel
- CHOC Children's Research Institute, Neuro-oncology and Stem Cell Research Laboratory (NSCL), Center for Neuroscience Research (CNR), Children's Hospital of Orange County (CHOC), 1201 W. La Veta Ave.; Orange, CA 92868-3874, United States of America
| | - Mustafa H Kabeer
- Pediatric Surgery, Children's Hospital of Orange County, Orange, CA 92868-3874, United States of America.,Department of Surgery, University of California-Irvine School of Medicine, 333 City Blvd. West, Suite 1600, Orange, CA 92868, United States of America
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