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Determining the best candidates for surgical treatment of idiopathic thrombocytopenic purpura (ITP) is largely patient specific, says Howard A. Liebman, MD. Some patients opt for surgical intervention if they encounter difficulty taking medications. The response rates in younger women tends to be in the range of 65%, while individuals older than 50 years have lower response rates. Unfortunately, there is not a definitive way to predict who is going to respond, notes Liebman.
Laparoscopic splenectomy is generally a low-risk, but not a no-risk, procedure, says Ivy Altomare, MD. Perioperative mortality is approximately 1%, and infection, bleeding, and postoperative complications are estimated at 9% to 20%. Once a patient has had a splenectomy they have a long-term risk of sepsis, thrombosis, and atherosclerosism, Altomare warns. In general, a durable response is achieved in about two-thirds of patients.
Over the course of a 6-year study, only 7% of newly diagnosed patients had their spleens removed, Altomare notes. Key indications for a splenectomy would include poor response to steroids and other treatments and excessive bleeding for aggressive forms of ITP, notes Keith McCrae, MD.