BACKGROUND: This study aimed to evaluate whether laparoscopic splenectomy (Lap-Sp) contributes to the completion and curability of combined peginterferon and ribavirin (peg-IFN + RIB) therapy for cirrhotic patients with pancytopenia due to hypersplenism. METHODS: From December 2004 to September 2007, 21 patients underwent Lap-Sp before treatment with peg-IFN + RIB. All the patients were Child-Pugh class A or B with a mean platelet count of 5.7 x 10(4)/mm(3) and a mean leukocyte count of 2,830/mm(3). The hepatitis C virus (HCV) genotype was 1b for 18 patients and 2b for 3 patients. Of the 21 patients, 17 had a viral load exceeding 100 KIU/ml, and 4 had a load of less than 100 KIU/ml. RESULTS: All the patients underwent Lap-Sp without severe complications. The average hospital stay was 12.7 days (range, 6-23 days). Platelet counts increased from a mean of 5.7 +/- 2.2 x 10(4)/mm(3) preoperatively to 19.6 +/- 7.6 x 10(4)/mm(3) postoperatively and remained above 7.0 x 10(4)/mm(3) during the subsequent peg-IFN + RIB therapy. The full course of therapy was completed for nine patients, with five obtaining a sustained virologic response and one obtaining a biologic response. The five patients who obtained a sustained virologic response had either HCV type 2b or 1b with a low viral load (<100 KIU). At this writing, treatment is ongoing for the remaining 12 patients. CONCLUSIONS: Laparoscopic splenectomy allows patients with HCV cirrhosis and hypersplenism to receive full-dose peg-IFN + RIB therapy. Patients with HCV, genotype 2 or 1b and a low viral load, and hypersplenism may be good candidates for Lap-Sp.
BACKGROUND: This study aimed to evaluate whether laparoscopic splenectomy (Lap-Sp) contributes to the completion and curability of combined peginterferon and ribavirin (peg-IFN + RIB) therapy for cirrhoticpatients with pancytopenia due to hypersplenism. METHODS: From December 2004 to September 2007, 21 patients underwent Lap-Sp before treatment with peg-IFN + RIB. All the patients were Child-Pugh class A or B with a mean platelet count of 5.7 x 10(4)/mm(3) and a mean leukocyte count of 2,830/mm(3). The hepatitis C virus (HCV) genotype was 1b for 18 patients and 2b for 3 patients. Of the 21 patients, 17 had a viral load exceeding 100 KIU/ml, and 4 had a load of less than 100 KIU/ml. RESULTS: All the patients underwent Lap-Sp without severe complications. The average hospital stay was 12.7 days (range, 6-23 days). Platelet counts increased from a mean of 5.7 +/- 2.2 x 10(4)/mm(3) preoperatively to 19.6 +/- 7.6 x 10(4)/mm(3) postoperatively and remained above 7.0 x 10(4)/mm(3) during the subsequent peg-IFN + RIB therapy. The full course of therapy was completed for nine patients, with five obtaining a sustained virologic response and one obtaining a biologic response. The five patients who obtained a sustained virologic response had either HCV type 2b or 1b with a low viral load (<100 KIU). At this writing, treatment is ongoing for the remaining 12 patients. CONCLUSIONS: Laparoscopic splenectomy allows patients with HCV cirrhosis and hypersplenism to receive full-dose peg-IFN + RIB therapy. Patients with HCV, genotype 2 or 1b and a low viral load, and hypersplenism may be good candidates for Lap-Sp.
Authors: Emily R Winslow; L Michael Brunt; Jeffery A Drebin; Nathaniel J Soper; Mary E Klingensmith Journal: Am J Surg Date: 2002-12 Impact factor: 2.565
Authors: K Ikeda; S Saitoh; Y Arase; K Chayama; Y Suzuki; M Kobayashi; A Tsubota; I Nakamura; N Murashima; H Kumada; M Kawanishi Journal: Hepatology Date: 1999-04 Impact factor: 17.425
Authors: Kent W Kercher; Alfredo M Carbonell; B Todd Heniford; Brent D Matthews; Dawn M Cunningham; Robert W Reindollar Journal: J Gastrointest Surg Date: 2004-01 Impact factor: 3.452
Authors: Alejandro Soza; James E Everhart; Marc G Ghany; Edward Doo; Theo Heller; Kittichai Promrat; Yoon Park; T Jake Liang; Jay H Hoofnagle Journal: Hepatology Date: 2002-11 Impact factor: 17.425
Authors: K Sumida; S Shimoda; S Iwasaka; S Hisamoto; H Kawanaka; T Akahoshi; T Ikegami; K Shirabe; N Shimono; Y Maehara; C Selmi; M E Gershwin; K Akashi Journal: Clin Exp Immunol Date: 2013-10 Impact factor: 4.330