A HUNDRED YEARS AFTER FIRST SPLENECTOMY FOR IMMUNE THROMBOCYTOPENIA, IS LAPAROSCOPIC SPLENECTOMY STILL VALID AS A TREATMENT OPTION? A SINGLE CENTER EXPERIENCE
Zdravko Mitrović, Igor Stipančić, Josip Baković, Višnja Hariš, Radmila Ajduković, Ozren Jakšić, Željko Prka, Mario Piršić, Mario Knežević, Vlatko Pejša
Aim: A single center experience with laparoscopic splenectomy (LS) in the treatment of immune thrombocytopenia (ITP) is presented in this paper. In addition, we discuss the role of splenectomy in the era of thrombopoietin receptor agonists (TPO-RAs). Patients and methods: In this retrospective study, we present our 35 patients who underwent LS in the period of 12 years. There were 26 women and nine men with a median age of 50 years (ranging from 19 to 85 years). Prior to LS, all patients were treated with glucocorticoids +/- intravenous immunoglobulins (IVIG), whereas seven patients received also rituximab. The median time to splenectomy was seven months (ranging from one to 103 months). Results: Four (11%) patients failed to reach response after LS, and additional six patients relapsed during the follow up. After a median follow up of 33 months, the remaining 25 (71%) patients required no further treatment. The estimated sustained response rate at five years was 59%. Patients who underwent splenectomy in the first year after the diagnosis had better outcome when compared to patients with delayed splenectomy (P= 0.048). Sex and age did not influence the treatment outcome. Four patients had early serious postoperative complications of LS: portal vein thrombosis, deep vein thrombosis of the leg, sepsis, and intraperitoneal bleeding that required surgical revision. There were no deaths, nor late serious infections. Ten (29%) patients reported fatigue after LS. Conclusions: Long-term cure rate of about 60% is comparable to other studies. However, we observed better response in patients who underwent splenectomy earlier. In our opinion, LS may still be considered as a safe, successful, and cost-effective second-line treatment of ITP, especially in patients who are in favor of fast and highly curative treatment. Nevertheless, the introduction of TPO-RAs will inevitably decrease the role of LS in Croatia, as in the western world.