Long-Term Results of Splenectomy in Patients Diagnosed with Primary-Chronic Idiopathic Thrombocytopenic Purpura: A Single Center Experience of 300 Patients

Abstract

The aim of this study was to determine the long results of splenectomy performed in patients with Idiopathic Thrombocytopenic Purpura (ITP) and to discuss them in the light of the literature. Three-hundred patients who underwent splenectomy for chronic ITP between 2008 and 2017 were retrospectively included in the study. Data were obtained from patients' medical records and surgical notes. Patients, gender, complaints at presentation, major bleeding status, platelet counts and other hematological parameters, first-line therapy combinations, splenectomy procedures (open or laparoscopic), postoperative platelet counts and splenectomy, early and late results after splenectomy, recurrence, mortality and morbidity, and the need for tertiary treatment after splenectomy were analyzed. Six of all patients who underwent splenectomy due to chronic ITP were excluded from the study due to lack of data. Thus, 300 patients (88 men and 212 women) were included in the study. 254 (84,6%) patients had complete response, 2 (4%) patients had response, and 46 (15,3%) patients had no response to treatment. The recurrence rate of ITP at two years was 44 (14,6%). ITP is one of the most common hematological diseases in terms of applicability of both medical and surgical treatments and is known as the first choice steroid in today's treatment algorithm. Splenectomy still seems to be an important treatment option in patients who do not respond to medical treatment, develop drug side effects or need high-dose steroids.

Keywords

• Immune (idiopathic) thrombocytopenic purpura
• response to treatment
• splenectomy

Primer-Kronik İdiyopatik Trombositopenik Purpuralı Tanılı Hastalarda Splenektominin Uzun Dönem Sonuçları: 300 Hastadan Oluşan Tek Merkez Deneyimi

Abstract

Mevcut çalışma kapsamında, İdiyopatik Trombositopenik Purpuralı (İTP) hastalarında yapılan splenektominin uzun sonuçlarını belirleyerek literatür eşliğinde tartışmak amaçlanmıştır. 2008 ve 2017 yılları arasında Kronik ITP nedeniyle splenektomi yapılan 300 hasta, retrospektif olarak çalışmaya dahil edildi. Veriler, hastaların tıbbi kayıtlarından ve ameliyat notlarından elde edildi. Hastalar, cinsiyet, başvuru anındaki şikayet, majör kanama durumu, trombosit sayıları ve diğer hematolojik parametreler, ilk basamak tedavi kombinasyonları, splenektomi prosedürleri (açık veya laparoskopik), postoperatif trombosit sayıları ve splenektomi ile ilgili olarak, splenektomi sonrası erken ve geç dönem sonuçları, rekürrens, mortalite ve morbidite, splenektomi sonrası üçüncü basamak tedavi ihtiyacı açısından değerlendirildi. Kronik ITP nedeniyle splenektomi yapılan 306 hastanın 6’sı veri eksikliği nedeniyle çalışma dışı bırakıldı. Verisine ulaşılan 300 hasta (88 erkek ve 212 kadın) çalışmaya dahil edildi. 254 (% 84,6) hastada tam yanıt, 2 (% 4) hastada yanıt vardı ve 46 (% 15,3) hastada ise yanıtsızlık vardı. ITP'nin iki yıldaki rekürrens oranı 44 (% 14.6) idi. İTP hem medikal hem de cerrahi tedavilerin uygulanabilirliği açısından en çok görülen hematolojik hastalıklardan biridir ve günümüz tedavi algoritmasında ilk seçenek steroid olarak bilinmektedir. Medikal tedaviye yanıt alınamayan, ilaç yan etkisi gelişen veya yüksek doz steroid ihtiyacı olan hastalarda ise splenektomi halen önemli bir tedavi seçeneği olarak görünmektedir.

Keywords

• İmmün (idiyopatik) trombositopenik purpura
• tedaviye yanıt
• splenektomi

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