Luciano Guilherme Tastaldi, MD, David M Krpata, MD, Clayton Petro, MD, Ajita S Prabhu, MD, FACS, Deepa Cherla, MD, Ivy N Haskins, MD, Sue Ting Lim, MD, Alan Lichtin, MD, Michael J Rosen, MD, FACS, Steven Rosenblatt, MD, FACS. Cleveland Clinic Foundation
Background: Despite the advent of modern second-line medical therapies for immune thrombocytopenia (ITP), splenectomy remains the only potentially curative option for this condition. The adoption of the laparoscopic platform has allowed for decreased morbidity while providing equivalent hematologic outcomes. We aimed to characterize the outcomes of a modern cohort of patients undergoing laparoscopic splenectomy (LS) for ITP at our institution.
Methods: Adult patients with ITP who have undergone LS by the senior author from 2002-2016 were identified in a prospectively maintained database. Retrospective review of the medical record was supplemented with telephone interviews when necessary. ITP response criteria were defined by an ITP International Working Group as complete responders (CR), responders (R), non-responders (NR) or relapses. Kaplan-Meier estimates were used to assess relapse-free survival rates and predictors of long-term response were determined using logistic regression modeling.
Results: A total of 109 patients met inclusion criteria (60.5% female; mean age 47.5±20.6). The median duration of drug treatment was 13.4 months (IQR 4.8,41.2) and 46% had been treated with a second-line medical therapy. LS was completed in all cases, with no conversions or intraoperative complications. The perioperative complications rate was 7.3%, including five venous thromboembolic events (4.6%: 3 deep vein, 2 portal vein thrombosis), one reoperation for bleeding (0.9%), one pneumonia, one episode of bacteremia, and no mortalities. Splenectomy was initially effective in 99 patients (CR+R=90.8%), and 10 patients were considered NR. At a median follow-up of 60 months (IQR 29-105), there were 25 relapses, accounting for a 68% (CR+R) long-term sustained response rate. CR+R patients were younger (44.7±20 vs.53.4±19, p0.03), had higher median preoperative platelet counts (36.5 vs.19, p0.01), and had a higher increment in their platelet count during their postoperative hospital stay (117 vs.38, p<0.001) as well as 30-days postoperatively (329 vs.124, p<0.001). Using multivariate analysis, only a robust response in platelet count at 30-days postoperatively was associated independently with long-term sustained response (OR1.005, 95%CI 1.0016-1.0085, p0.006).
Conclusion: In a modern cohort of ITP patients, LS is safe, with low perioperative morbidity and a 68% long-term response rate that can only be anticipated by an initial response in platelet count 30-days postoperatively.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85948
Program Number: S134
Presentation Session: Solid Organ Session
Presentation Type: Podium