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Splenectomy in the management of E vans syndrome in adults: Long‐term follow up of 32 patients
Author(s) -
Li Yongbin,
Pankaj Prasoon,
Wang Xin,
Wang Yichao,
Peng Bing
Publication year - 2014
Publication title -
surgical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.109
H-Index - 10
eISSN - 1744-1633
pISSN - 1744-1625
DOI - 10.1111/1744-1633.12043
Subject(s) - splenectomy , medicine , perioperative , haemolysis , demographics , refractory (planetary science) , platelet , surgery , gastroenterology , immunology , spleen , physics , demography , sociology , astrobiology
Aim Literature relating to the long‐term outcome after splenectomy for Evans syndrome ( ES ) is limited, therefore, in the present study, we sought to examine the clinical experience of splenectomy for ES , paying particular attention to the long‐term outcome related to the disease process requiring splenectomy. Patients and Methods We retrospectively reviewed a series of splenectomies for ES from J anuary 1992 to J anuary 2012. Patients' demographics, indications for splenectomy, perioperative morbidity and mortality were investigated. Haematological outcomes were followed in both the short term (postoperative 30 days) and long term (last contact or death). Response to splenectomy was ranked as: complete response [ CR , platelet (PLT) ≥ 100 × 10 9 /L, haemoglobin (Hb) ≥ 120 g/L, without haemolysis and transfusion], partial response ( PR , PLT = 50–99 × 10 9 /L, Hb: 100–119 g/L or an increase of at least 20 g/L from baseline), no response ( NR , any others), relapse (PLT < 50 × 10 9 /L or Hb drop > 20 g/L from CR or PR ). Results A total of 32 patients fulfilled the inclusion criteria of splenectomy for ES. Indications for splenectomy included: refractory to 19 (59 per cent) treatments, dependent on nine (28 per cent) treatments and patient intolerance of four (13 per cent) treatments. None of patients experienced perioperative mortality. Perioperative morbidity was 19 per cent, and the short‐term response was 72 per cent. After a mean follow up of 6.9 ± 4.9 (0.1–20) years, 21 (66 per cent) patients achieved long‐term response, including 13 (41 per cent) CR and eight (25 per cent) PR . The remaining 11 (34 per cent) patients had NR ; six of those 11 patients suffered relapse. Conclusions Splenectomy should be considered a safe and efficacious approach for ES .