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Long-term outcome after laparoscopic splenectomy related to hematologic diagnosis

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Abstract

Background

Laparoscopic splenectomy (LS) has been demonstrated as an effective and safe treatment for hematological disorders requiring spleen removal, especially in cases of normal-sized spleens. However, although results are promising, long-term outcome data are lacking. We reviewed our clinical experience with LS in a series of 255 cases, with particular attention to the long-term outcome related to the disease process requiring LS.

Methods

From February 1993 to October 2003, LS was attempted in 255 patients (100 males and 155 females with a mean age of 45 ± 19 years) and clinical information was recorded in a prospective database. Indications for splenectomy included idiopathic thrombocytopenic purpura (ITP) (n = 115), HIV-ITP (n = 9), Evans syndrome (n = 6), autoimmune hemolytic anemia (AIHA) (n = 13), hereditary spherocytosis (HS) (n = 19), hematologic malignancy (n = 66), thrombotic thrombocytopenic purpura (n = 1), and others (n = 26). Long-term postoperative follow-up evaluation was obtained through clinical notes, follow-up visits by the referring hematologist, and by phone interviews both with patients and with the referring hematologist.

Results

A total of 186 patients (73%) were available for a mean follow-up of 35 months (range, 1–104). Of the ITP patients, 87 (76%) were followed up, with a remission rate of 89% (complete remission in 75%). A similar remission rate was observed in ITP-HIV; in patients available for follow-up (78%), complete remission was achieved in 83%. In Evans, complete remission was achieved in all patients available for follow-up (67%). Clinical response for hemolytic disease ranged between 70% for AIHA and 100% for HS. In the malignant group, the late mortality rate was 22%. The mortality rate in the miscellaneous group was 5%. No cases of splenectomy-related sepsis occurred during follow-up.

Conclusions

LS offers advantages for all types of splenic diseases requiring surgery. It provides not only good clinical short-term outcome but also satisfactory long-term hematological results.

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References

  1. J Aksnes M Abdelnoor O Mathisen (1995) ArticleTitleRisk factors associated with mortality and morbidity after elective splenectomy Eur J Surg 161 253–258 Occurrence Handle1:STN:280:ByqA3sjisFU%3D Occurrence Handle7612767

    CAS  PubMed  Google Scholar 

  2. OE Akwari KMF Itan RE Coleman WF Rosse (1997) ArticleTitleSplenectomy for primary and recurrent immune thrombocytopenic purpura (ITP) Ann Surg 206 529–541

    Google Scholar 

  3. JE Coad E Matutes D Catovsky (1993) ArticleTitleSplenectomy in lymphoproliferative disorders: a report of 70 cases and review of the literature Leuk Lymphoma 10 245–264 Occurrence Handle1:STN:280:ByuD3svns1I%3D Occurrence Handle8220125

    CAS  PubMed  Google Scholar 

  4. B Cola E Tonielli S Sacco (1986) ArticleTitleSurgical treatment of chronic idiopathic thrombocytopenic purpura: results in 107 cases Int Surg 71 195–198 Occurrence Handle1:STN:280:BiiD3s3nt1c%3D Occurrence Handle3771123

    CAS  PubMed  Google Scholar 

  5. W Coon (1998) ArticleTitleSurgical aspects of splenic disease and lymphoma Curr Problems Surg 35 547–632

    Google Scholar 

  6. B Delaitre B Maignien (1991) ArticleTitleSplenectomy by the coelioscopic approach: report of a case Presse Med 20 2263 Occurrence Handle1:STN:280:By2C2c7htVE%3D

    CAS  Google Scholar 

  7. JR Delpero G Houvenaeghel JA Gastaut P Orsoni JL Blache G Guerinel Y Carcassonne (1990) ArticleTitleSplenectomy for hypersplenism in chronic lymphocytic leukemia and malignant non-Hodgkin’s lymphoma Br J Surg 77 443–449 Occurrence Handle1:STN:280:By%2BB2MvjvFA%3D Occurrence Handle2340397

    CAS  PubMed  Google Scholar 

  8. KL Harold RT Schinklert DK Mann CB Reeder P Noel TR Fitch TA Braich JK Camoriano (1999) ArticleTitleLong-term results of laparoscopic splenectomy for immune thrombocytopenic purpura Mayo Clinic Proc 74 37–39 Occurrence Handle1:STN:280:DyaK1M7kt1SjsQ%3D%3D

    CAS  Google Scholar 

  9. WJ Harrington V Minnich JW Hollingsworth CV Moore (1951) ArticleTitleDemonstration of a thrombocytopenic factor in the blood of patients with thrombocytopenic purpura J Lab Clin Med 38 1–10 Occurrence Handle1:CAS:528:DyaG38XmtlGg Occurrence Handle14850832

    CAS  PubMed  Google Scholar 

  10. HA Johnson RA Deterling (1989) ArticleTitleMassive splenomegaly Surg Gynecol Obstet 168 137

    Google Scholar 

  11. N Katkhouda SW Grant E Mayor MH Friedlander RV Lord K Achanta R Essani R Mason (2001) ArticleTitlePredictors of response after laparoscopic splenectomy for immune thrombocytopenic purpura Surg Endosc 15 484–488 Occurrence Handle10.1007/s004640000355 Occurrence Handle1:STN:280:DC%2BD3M3mtl2gtw%3D%3D Occurrence Handle11353966

    Article  CAS  PubMed  Google Scholar 

  12. N Kathkouda MB Hurtwitz RT Rivera M Chandra DJ Waldrep J Gugenheim J Mouiel (1998) ArticleTitleLaparoscopic splenectomy: outcome and efficacy in 103 consecutive cases Ann Surg 228 568–578 Occurrence Handle10.1097/00000658-199810000-00013 Occurrence Handle1:STN:280:DyaK1M%2FgsFSjtA%3D%3D Occurrence Handle9790346

    Article  CAS  PubMed  Google Scholar 

  13. P Kaznelson (1916) ArticleTitleVerschwinden der hämorrhagischen Diathese bei einem Falle von essentieller Thrombopenia (frank) nach Milzextirpation: spleneogene thrombolytische purpura Wien Klin Wochenschr 29 1451–1454

    Google Scholar 

  14. S Kumar FE Diehn MA Gertz A Tefferi (2002) ArticleTitleSplenectomy for immune thrombocytopenic purpura: long-term results and treatment of postsplenectomy relapses Ann Hematol 81 312–319 Occurrence Handle10.1007/s00277-002-0461-8 Occurrence Handle1:CAS:528:DC%2BD38Xks1Sku7w%3D Occurrence Handle12107560

    Article  CAS  PubMed  Google Scholar 

  15. RV Lord MF Coleman ST Milliken (1998) ArticleTitleSplenectomy for HIV-related immune thrombocytopenia Arch Surg 133 205–210 Occurrence Handle10.1001/archsurg.133.2.205 Occurrence Handle1:STN:280:DyaK1c7ktlaltw%3D%3D Occurrence Handle9484736

    Article  CAS  PubMed  Google Scholar 

  16. J Pizzuto R Ambriz (1984) ArticleTitleTherapeutic experience on 934 adults with idiopathic thrombocytopenic purpura: multicentric trail of the cooperative Latin American group on hemostasis and thrombosis Blood 64 1179–1183 Occurrence Handle1:STN:280:BiqD2cjlt1U%3D Occurrence Handle6388663

    CAS  PubMed  Google Scholar 

  17. RV Rege RJ Jowhl (1999) ArticleTitleA learning curve for laparoscopic splenectomy at an academic institution J Surg Res 81 27–32 Occurrence Handle10.1006/jsre.1998.5485 Occurrence Handle1:STN:280:DyaK1M7gvVSgug%3D%3D Occurrence Handle9889053

    Article  CAS  PubMed  Google Scholar 

  18. M Rosen F Brody RM Walsh M Tarnoff J Mahn J Ponsky (2002) ArticleTitleOutcome of laparoscopic splenectomy based on hematologic indication Surg Endosc 16 272–279 Occurrence Handle10.1007/s00464-001-8150-6 Occurrence Handle1:STN:280:DC%2BD383jtVWqsg%3D%3D Occurrence Handle11967677

    Article  CAS  PubMed  Google Scholar 

  19. WJ Rudowski (1985) ArticleTitleAccessory spleens: clinical significance with particular reference to the recurrence of idiopathic thrombocytopenic purpura World J Surg 9 422–430 Occurrence Handle1:STN:280:BiqB2cnmsVc%3D Occurrence Handle4040299

    CAS  PubMed  Google Scholar 

  20. CJ Stanton (1999) ArticleTitleLaparoscopic splenectomy for idiopathic thrombocytopenic purpura (ITP): a five-year experience Surg Endosc 13 1083–1086 Occurrence Handle10.1007/s004649901178 Occurrence Handle1:STN:280:DC%2BD3c%2FivVCjtQ%3D%3D Occurrence Handle10556443

    Article  CAS  PubMed  Google Scholar 

  21. GA Sutherland FF Burghard (1910) ArticleTitleThe treatment of splenic anemia by splenectomy Lancet 2 1819–1822 Occurrence Handle10.1016/S0140-6736(00)52857-8

    Article  Google Scholar 

  22. EM Targarona C Balagué M Trías (2001) ArticleTitleHand-assisted laparoscopic splenectomy Semin Laparosc Surg 8 126–134 Occurrence Handle10.1053/slas.2001.25148 Occurrence Handle1:STN:280:DC%2BD3MzoslWktQ%3D%3D Occurrence Handle11441401

    Article  CAS  PubMed  Google Scholar 

  23. EM Targarona C Balagué M Trías (2002) ArticleTitleLaparoscopic splenectomy for splenomegaly. Problems in general surgery Surgery 19 58–64

    Google Scholar 

  24. EM Targarona G Cerdán E Gracia M Rodríguez M Trías (2001) ArticleTitleResults of laparoscopic splenectomy for treatment of malignant conditions HPB Surg 3 251–255 Occurrence Handle10.1080/136518201753335746

    Article  Google Scholar 

  25. EM Targarona JJ Espert C Balagué G Sugrañes C Ayuso M Trías (1998) ArticleTitleResidual splenic function after laparoscopic splenectomy A clinical concern. Arch Surg . 56–60

    Google Scholar 

  26. M Trías EM Targarona JJ Espert C Balagué (1998) ArticleTitleLaparoscopic surgery for splenic disorders. Lessons learned from a series of 64 cases Surg Endosc 12 66–72 Occurrence Handle10.1007/s004649900597 Occurrence Handle9419309

    Article  PubMed  Google Scholar 

  27. M Trías EM Targarona JJ Espert G Cerdan E Bombuy O Vidal V Artigas (2000) ArticleTitleImpact of hematological diagnosis on early and late outcome after laparoscopic splenectomy. An analysis of 111 cases Surg Endosc 14 556–560 Occurrence Handle10.1007/s004640000149 Occurrence Handle10890965

    Article  PubMed  Google Scholar 

  28. Z Tsereteli CD Smith GD Branum JR Galloway RJ Amerson H Chakaraborty JG Hunter (2001) ArticleTitleAre the favorable outcomes of splenectomy predictable in patients with idiopathic thrombocytopenic purpura (ITP)? Surg Endosc 15 1386–1389 Occurrence Handle1:STN:280:DC%2BD383ivVSltQ%3D%3D Occurrence Handle11965451

    CAS  PubMed  Google Scholar 

  29. D Watson B Coventry T Chin G Gill P Malycha (1997) ArticleTitleLaparoscopic versus open splenectomy for immune thrombocytopenic purpura Surgery 11 18–22 Occurrence Handle10.1016/S0039-6060(97)90177-X

    Article  Google Scholar 

  30. LF Yee SH Carvajal AA Lorimer ParticleDe SJ Malvihill (1995) ArticleTitleLaparoscopic splenectomy Arch Surg 130 874–879 Occurrence Handle1:STN:280:ByqA2MfmvFA%3D Occurrence Handle7632149

    CAS  PubMed  Google Scholar 

Download references

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Authors and Affiliations

  1. Service of General and Digestive Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Avda P Claret 167, 08025, Barcelona, Spain

    C. Balagué, E. M. Targarona, G. Cerdán, J. Novell, O. Montero, G. Bendahan, A. García, A. Pey, S. Vela, M. Diaz & M. Trías

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  1. C. Balagué
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  2. E. M. Targarona
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  3. G. Cerdán
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  4. J. Novell
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  5. O. Montero
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  6. G. Bendahan
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  7. A. García
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  8. A. Pey
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  9. S. Vela
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  10. M. Diaz
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  11. M. Trías
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Correspondence to E. M. Targarona.

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Balagué, C., Targarona, E.M., Cerdán, G. et al. Long-term outcome after laparoscopic splenectomy related to hematologic diagnosis. Surg Endosc 18, 1283–1287 (2004). https://doi.org/10.1007/s00464-003-9092-y

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