Laparoscopic splenectomy for primary immune thrombocytopenia:Current status and challenges

Primary immune thrombocytopenia(ITP) is an immunemediated 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 longterm outcome of splenectomy which can help make the decision of operation.

Long-term outcome and prognostic factors of combined hepatocellular carcinoma and cholangiocarcinoma after curative resection

Background:Combinedhepatocellular carcinoma and cholangiocarcinoma(cHCC-CC)is a rare subtype of primary liver cancers.Its prognostic factors remain unclear.The study aimed to evaluate its long-termoutcome and prognostic factors by retrospectively reviewing the series of cHCC-CC after curative resection from our institute.Methods:Atotal of 55 pathologically confirmed cHCC-CC patients undergoing curative resections between January 2003 and January 2018 at the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)were included.The clinicopathological and follow-up data were retrieved.Overall survival(OS)and recurrence-free survivals(RFS)were analysed by Kaplan–Meier curve.The independent prognostic factors were determined by using univariate andmultivariate Cox analyses.Results:Therewere 41 males and 14 females,with a median age of 51.0(interquartile range,44.0–60.0)years.The 1-,3-,and 5-year OS and RFS rates in cHCC-CC were 80.0%,25.5%,and 16.4%,respectively,and 52.7%,21.8%,and 10.9%,respectively.The median OS and RFS were 24.9 and 14.5 months,respectively.Univariate and multivariate analyses revealed that elevated alpha-fetal protein(AFP)and/or CA19-9,vascular invasion,local extra-hepatic invasion,and lymph-node metastasis(LNM)were independent unfavorable prognostic factors for OS and RFS(all P<0.005).Furthermore,elevated AFP and/or CA19-9 were independent unfavorable prognostic factors in various subgroups of cHCC-CC,including patients aged<60 years,positive hepatitis B surface antigen,cirrhosis,single tumor,tumor size5 cm,no vascular invasion,no LNM,and no local extra-hepatic invasion(all P<0.05).Conclusions:ElevatedAFP and/or CA19-9,vascular invasion,local extra-hepatic invasion,and LNM were independent unfavorable prognostic factors for long-term survival of cHCC-CC undergoing curative resections.Patients with normal levels of AFP and CA19-9 had better prognosis.

Values of spleen-preserving distal pancreatectomy in well-differentiated non-functioning pancreatic neuroendocrine tumors:a comparative study

Background The feasibility of spleen-preserving distal pancreatectomy(SPDP)to treat well-differentiated non-functioning pancreatic neuroendocrine tumors(NF-pNETs)located at the body and/or tail of the pancreas remains controversial.Distal pancreatectomy with splenectomy(DPS)has been widely applied in the treatment of NF-pNETs;however,it may increase the post-operative morbidities.This study aimed to evaluate whether SPDP is inferior to DPS in post-operative outcomes and survivals when being used to treat patients with NF-pNETs in our institute.Methods Clinicopathological features of patients with NF-pNETs who underwent curative SPDP or DPS at the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between January 2010 and January 2022 were collected.Short-term outcomes and 5-year survivals were compared between patients undergoing SPDP and those undergoing DPS.Results Sixty-three patients(SPDP,27;DPS,36)with well-differentiated NF-pNETs were enrolled.All patients had grade 1/2 tumors.After identifying patients with T1–T2 NF-pNETs(SPDP,27;DPS,15),there was no disparity between the SPDP and DPS groups except for tumor size(median,1.4 vs 2.6 cm,P=0.001).There were no differences in operation time(median,250 vs 295 min,P=0.478),intraoperative blood loss(median,50 vs 100 mL,P=0.145),post-operative major complications(3.7%vs 13.3%,P=0.287),clinically relevant post-operative pancreatic fistula(22.2%vs 6.7%,P=0.390),or post-operative hospital stays(median,9 vs 9 days,P=0.750)between the SPDP and DPS groups.Kaplan–Meier curve showed no significant differences in the 5-year overall survival rate(100%vs 100%,log-rank P>0.999)or recurrence-free survival(100%vs 100%,log-rank P>0.999)between patients with T1–T2 NF-pNETs undergoing SPDP and those undergoing DPS.Conclusions In patients with T1–T2 well-differentiated NF-pNETs,SPDP could achieve comparable post-operative outcomes and prognosis compared with DPS.