Value of splenectomy in treating autoimmune hematological diseases

doi:10.3877/cma.j.issn.2095-3232.2019.05.006

Abstract

Abstract:

Objective

To investigate the application value of splenectomy in the treatment of autoimmune hematological diseases.

Methods

Clinical data of 85 patients with autoimmune hematological diseases who underwent splenectomy in Peking University People's Hospital from January 2003 to January 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 26 patients were male and 59 female, aged 18-71 yearswith a median age of 39 years. 69 patients were diagnosed with primary immune thrombocytopenia (ITP), 12 with autoimmune hemolytic anemia (AHA) and 4 with Evans syndrome. The first-line treatment of glucocorticoid or gamma globulin in some patients failed, and some were hormone intolerant or disease recurred. The patients were divided into the open splenectomy group (n=55) and laparoscopic splenectomy group (n=30) according to different surgical procedure. Routine blood tests were conducted after operation at regular intervals. Postoperative complications and clinical efficacy were closely observed. The length of hospital stay was statistically compared between two groups by unpaired t test. The rate comparison was performed by Chi-square test.

Results

The incidence of postoperative complications in the laparoscopic splenectomy group was 13%(4/30), where no significant difference was observed from 18%(10/55) in the open splenectomy group (χ2=0.76, P>0.05). In the laparoscopic splenectomy group, the average length of hospital stay was (5.3±0.7) d, significantly shorter than (7.0±1.6) d in the open splenectomy group (t=-2.87, P<0.05). The 1- and 5-year complete remission rates were 78%(54/69) and 61%(42/69) for ITP patients, 83%(10/12) and 58%(7/12) for AHA patients, and 4/4 and 2/4 for Evans syndrome patients, respectively.

Conclusions

Splenectomy is a reliable and effective second-line treatment for autoimmune hematological diseases. Laparoscopic splenectomy is as safe and effective as open splenectomy, whereas it is minimally invasive and accelerates the postoperative recovery

Key words: Splenectomy, Thrombocytopenia, Anemia, hemolytic, autoimmune

Zhiping Hu, Dong Wang, Jiye Zhu. Value of splenectomy in treating autoimmune hematological diseases[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(05): 400-404.

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References 20

[1]	Sys J, Provan D, Schauwvlieghe A, et al. The role of splenectomy in autoimmune hematological disorders: outdated or still worth considering?[J]. Blood Rev, 2017, 31(3): 159-172.
[2]	Kojouri K, Vesely SK, Terrell DR, et al. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications[J]. Blood, 2004, 104(9):2623-2634.
[3]	Vianelli N, Galli M, de Vivo A, et al. Efficacy and safety of splenectomy in immune thrombocytopenic purpura: long-term results of 402 cases[J]. Haematologica, 2005, 90(1): 72-77.
[4]	Lechner K, Jäger U. How I treat autoimmune hemolytic anemias in adults[J]. Blood, 2010, 116(11):1831-1838.
[5]	Packman CH. Hemolytic anemia due to warm autoantibodies[J]. Blood Rev, 2008, 22(1):17-31.
[6]	Allgood JW, Chaplin H Jr. Idiopathic acquired autoimmune hemolytic anemia. a review of forty-seven cases treated from 1955 through 1965[J]. Am J Med, 1967, 43(2): 254-273.
[7]	Genty I, Michel M, Hermine O, et al. Characteristics of autoimmune hemolytic anemia in adults: retrospective analysis of 83 cases[J]. Rev Med Interne, 2002, 23(11): 901-909.
[8]	Wasserstrom H, Bussel J, Lim LC, et al. Memory B cells and pneumococcal antibody after splenectomy[J]. J Immunol, 2008, 181(5): 3684-3689.
[9]	Thomsen RW, Schoonen WM, Farkas DK, et al. Risk for hospital contact with infection in patients with splenectomy: a population-based cohort study[J]. Ann Intern Med, 2009, 151(8): 546-555.
[10]	Kyaw MH, Holmes EM, Toolis F, et al. Evaluation of severe infection and survival after splenectomy[J]. Am J Med, 2006, 119(3): 276, e1-7.
[11]	Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia[J]. Blood, 2010, 115(2): 168-186.
[12]	Mahévas M, Coignard-Biehler H, Michel M, et al. Post-splenectomy complications in primary immune thrombocytopenia. literature review and preventive measures[J]. Rev Med Interne, 2014, 35(6): 382-387.
[13]	Ikeda M, Sekimoto M, Takiguchi S, et al. High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: a prospective study with contrast-enhanced CT scan[J]. Ann Surg, 2005, 241(2): 208-216.
[14]	Ikeda M, Sekimoto M, Takiguchi S, et al. Total splenic vein thrombosis after laparoscopic splenectomy: a possible candidate for treatment[J]. Am J Surg, 2007, 193(1): 21-25.
[15]	Stamou KM, Toutouzas KG, Kekis PB, et al. Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric, and splenic veins[J]. Arch Surg, 2006,141(7): 663-669.
[16]	Velanovich V, Shurafa M. Laparoscopic excision of accessory spleen[J]. Am J Surg, 2000, 180(1): 62-64.
[17]	李波，亓玉忠，刘佳宁，等．腹腔镜脾切除术治疗血液系统疾病51例报道[J]．腹腔镜外科杂志，2010, 15(9): 662-663.
[18]	Portielje JE, Westendorp RG, Kluin-Nelemans HC, et al. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura[J]. Blood, 2001, 97(9): 2549-2554.
[19]	Rodeghiero F, Ruggeri M. Is splenectomy still the gold standard for the treatment of chronic ITP?[J]. Am J Hematol, 2008, 83(2): 91.
[20]	Palandri F, Polverelli N, Sollazzo D, et al. Have splenectomy rate and main outcomes of ITP changed after the introduction of new treatments? a monocentric study inthe outpatient setting during35 years[J]. Am J Hematol, 2016, 91(4): E267-272.

组别	例数	手术时间	术中出血量	住院时间
腔镜组	30	148±36	259±211	5.3±0.7
开腹组	55	134±36	290±159	7.0±1.6
t值	?	1.50	-0.69	-2.87
P值	?	>0.05	>0.05	<0.05

组别	例数	手术时间	术中出血量	住院时间
腔镜组	30	148±36	259±211	5.3±0.7
开腹组	55	134±36	290±159	7.0±1.6
t值	?	1.50	-0.69	-2.87
P值	?	>0.05	>0.05	<0.05

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