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World J Gastrointest Endosc. Sep 16, 2016; 8(17): 610-615
Published online Sep 16, 2016. doi: 10.4253/wjge.v8.i17.610
Laparoscopic splenectomy for primary immune thrombocytopenia: Current status and challenges
Dong Zheng, Chen-Song Huang, Shao-Bin Huang, Chao-Xu Zheng
Dong Zheng, Department of Hematology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
Chen-Song Huang, Shao-Bin Huang, Chao-Xu Zheng, Department of Pancreato-biliary Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
Author contributions: All authors contributed equally to this paper with conception and design of the study, literature review and analysis, drafting, critical revision and editing, and final approval of the final version.
Supported by Science and Technique Project of Guangdong Province, No. 2012B031800284.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chao-Xu Zheng, MD, PhD, Professor of Surgery, Department of Pancreato-biliary Surgery, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2 Road, Guangzhou 510080, Guangdong Province, China. zhengchaoxu@yahoo.com
Telephone: +86-20-87755766-6214 Fax: +86-20-87750632
Received: March 27, 2016
Peer-review started: March 28, 2016
First decision: May 17, 2016
Revised: June 2, 2016
Accepted: June 27, 2016
Article in press: June 29, 2016
Published online: September 16, 2016
Abstract

Primary immune thrombocytopenia (ITP) is an immune-mediated disorder affecting both adults and children, characterised by bleeding complications and low platelet counts. Corticosteroids are the first-line therapy for ITP, but only 20%-40% of cases achieve a stable response. Splenectomy is the main therapy for patients failing to respond to corticosteroids for decades, and about two-thirds of patients achieve a long-lasting response. Although some new drugs are developed to treat ITP as second-line therapies in recent years, splenectomy is still the better choice with less cost and more efficiency. Laparoscopic splenectomy (LS) for ITP proves to be a safe technique associated with lower morbidity and faster recovery and similar hematological response when compared to traditional open splenectomy. Based on the unified hematological outcome criteria by current international consensus, the response rate of splenectomy should be reassessed. So far, there are not widely accepted preoperative clinical indicators predicting favorable response to LS. Since the patients undergoing surgery take the risk of complications and poor hematological outcome, the great challenge facing the doctors is to identify a reliable biomarker for predicting long-term outcome of splenectomy which can help make the decision of operation.

Keywords: Laparoscopic splenectomy, Corticosteroids, Open splenectomy, Hematological outcome, Predictor, Biomarker, Immune thrombocytopenia

Core tip: Despite the new drugs developed to treat primary immune thrombocytopenia, splenectomy is still the main therapy for patients who fail corticosteroid treatment. Laparoscopic splenectomy proves to be a preferable technique compared to open splenectomy. The response rate to splenectomy should be reassessed based on the unified outcome criteria by current international consensus. So far, there are not widely accepted preoperative indicators predicting response to laparoscopic splenectomy. The challenge facing the doctors is to identify a reliable predictor of long-term outcome of splenectomy which can help make the decision of operation.