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Blood, 1 November 2004, Vol. 104, No. 9, pp. 2623-2634.
Prepublished online as a Blood First Edition Paper on June 24, 2004; DOI 10.1182/blood-2004-03-1168.
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Submitted March 30, 2004
Accepted May 31, 2004
Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications
Kiarash Kojouri, Sara K Vesely, Deirdra R Terrell, and James N George*
Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
* Corresponding author; email: jim-george{at}ouhsc.edu.
Splenectomy has been a standard treatment for adult patients with idiopathic thrombocytopenic purpura (ITP) for over 50 years. However the durability of responses, the ability to predict who will respond, and the frequency of surgical complications with splenectomy all remain uncertain. To better interpret current knowledge we systematically identified and reviewed all 135 case series, 1966-2004, that described 15 or more consecutive patients who had splenectomy for ITP and that had data for one of these 3 outcomes. Complete response was defined as a normal platelet count following splenectomy and for the duration of follow-up with no additional treatment. Forty-seven case series reported complete response in 1731 (66%) of 2623 adult patients with follow-up for 1-153 months; complete response rates did not correlate with duration of follow-up (r=-0.103, p=0.34). None of 12 pre-operative parameters that have been reported consistently predicted response to splenectomy. Mortality was 1.0% (48/4955 patients) with laparotomy and 0.2% (3/1301 patients) with laparoscopy. Complication rates were 12.9% (318/2465) with laparotomy and 9.6% (88/921 patients) with laparoscopic splenectomy. Although the risk of surgery is an important consideration, splenectomy provides a high frequency of durable responses for adult patients with ITP.
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