Impact of Experience on Outcomes After Endoscopic Transsphenoidal Surgery for Acromegaly

Goyal-Honavar, Abhijit; Sarkar, Sauradeep; Asha, Hesarghatta Shyamasunder; Kapoor, Nitin; Thomas, Regi; Rajan, Balakrishnan; Chacko, Geeta; Chacko, Ari G

doi:10.1016/j.wneu.2021.05.030

Cited by 12 publications

(6 citation statements)

References 28 publications

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“…Luca D'Angelo et al showed that stereotactic combined with endoscopic surgery is less invasive [ 32 ]. Transsphenoidal endoscopic surgery by a senior surgeon and increased surgical experience are important for improving remission rates [ 33 ]. In a prospective study of 50 patients, 28 of 33 functional adenomas achieved a response, and it was proposed that resection via extra-pseudo capsular or intra-pseudo capsular dissection could help improve resection and response rates [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

et al. 2023

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Purpose Currently, endoscopic transsphenoidal surgery is the main treatment for pituitary neuroendocrine tumors (PitNETs). Excision of the tumor may have positive or negative effects on pituitary endocrine function, and the pituitary function of somatotroph tumors is a point of particular concern after the operation. This study aimed to conduct a meta-analysis on the effect of endoscopic transsphenoidal somatotroph tumor resection on pituitary function. Methods A systematic literature search was conducted for articles that included the evaluation of pituitary target gland before and after endoscopic transsphenoidal pituitary tumor resection and were published between 1992 and 2022 in PubMed, Cochrane, and Ovid MEDLINE. Results Sixty-eight studies that included biochemical remission rates in 4524 somatotroph tumors were concluded. According to the 2000 consensus, the biochemical remission rate after transsphenoidal endoscopic surgery was 66.4% (95% CI, 0.622–0.703; P = 0.000), the biochemical remission rate was 56.2% according to the 2010 consensus (95% CI, 0.503–0.620; P = 0.041), and with the rate of biochemical remission ranging from 30.0 to 91.7% with investigator’s definition. After endoscopic resection, adrenal axis dysfunction was slightly higher than that before surgery, but the difference was not statistically significant. Hypothyroidism was 0.712 times higher risk than that before surgery (OR = 0.712; 95% CI, 0.527–0.961; P = 0.027). Hypogonadism was 0.541 times higher risk than that before surgery (OR = 0.541; 95% CI, 0.393–0.746; P = 0.000). Hyperprolactinemia was 0.131 times higher risk than that before surgery (OR = 0.131; 95% CI, 0.022–0.783; P = 0.026). The incidence of pituitary insufficiency was 1.344 times the risk before surgery after endoscopic resection of somatotroph tumors, but the difference was not statistically significant. Conclusions In patients with somatotroph tumors after undergoing endoscopic surgery, the risk of dysfunction and pituitary insufficiency tend to increase, while preoperative thyroid insufficiency, gonadal insufficiency, and hyperprolactinemia will be partially relieved.

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Section: Discussionmentioning

confidence: 99%

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

et al. 2023

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“…Second, the use of neuronavigation or intraoperative hormone monitoring can improve surgical outcomes [30]. Clearly, transsphenoidal endoscopic surgery by a senior surgeon and increased surgical experience is important for improving remission rates [31]. Age and sex are predictive of postoperative remission rates in some studies [32][33][34].…”

Section: Discussionmentioning

confidence: 99%

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

Nie

Fang

Wong

et al. 2022

Preprint

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Purpose Currently, endoscopic transsphenoidal surgery is the main treatment for pituitary neuroendocrine tumors (PitNets). Excision of the tumor may have positive or negative effects on pituitary endocrine function and the pituitary function of somatotroph tumors is a point of particular concern after the operation. This study aimed to conduct a meta-analysis on the effect of endoscopic transsphenoidal somatotroph tumor resection on pituitary function. Methods A systematic literature search was conducted for articles that included the evaluation of pituitary target gland before and after endoscopic transsphenoidal pituitary adenoma resection and published between 1992 and 2022 in PubMed, Cochrane, and Ovid MEDLINE. Results 68 studies that included biochemical remission rates in 4524 somatotroph tumors were concluded. According to the 2000 consensus, the biochemical remission rate after transsphenoidal endoscopic surgery was 66.4% (95%CI,0.622–0.703; P = 0.000), the biochemical remission rate was 56.2% according to the 2010 consensus (95%CI,0.503–0.620; P = 0.041), and with the rate of biochemical remission ranging from 30.0–91.7% with investigator's definition. After endoscopic resection, adrenal axis dysfunction was slightly higher than that before surgery, but the difference was not statistically significant. Hypothyroidism was 0.712 times higher risk than that before surgery(OR = 0.712; 95%CI, 0.527–0.961; P = 0.027). Hypogonadism was 0.541 times higher risk than that before surgery (OR = 0.541; 95%CI,0.393–0.746; P = 0.000). Hyperprolactinemia was 0.131 times higher risk than that before surgery (OR = 0.131; 95%CI,0.022–0.783; P = 0.026). The incidence of pituitary insufficiency was 1.344 times risk before surgery after endoscopic resection of somatotroph tumors, but the difference was not statistically significant. Conclusions Although the biochemical response rate of patients with transsphenoidal endoscopic growth hormone tumor resection will be increased as endoscopic surgery matures, some patients still require postoperative treatment, including gamma-ray therapy or drug take-in. Long-term follow-up and drug replacement therapy are required for newly diagnosed pituitary dysfunction, while the existing preoperative hypophysis can be ameliorated to some extent.

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“…The rationale for early postoperative imaging is to give surgeons a chance to intervene earlier for residual tumor (29). Important predictors of surgical outcome of GHsecreting PA are tumor size, invasiveness, duration of acromegaly, and preoperative GH levels (13). GHsecreting PA, the predominant cause of acromegaly, is associated with a standardized mortality rate of 0.72-1.13 (28).…”

Section: Discussionmentioning

confidence: 99%

“…Growth hormone (GH)secreting PA is an insidious disease with an estimated incidence of 30 to 50 cases/1 million population annually (12). Acromegaly is caused by an excess of GH, most commonly caused by a somatotroph PA, and is associated with significant metabolic changes that have a negative impact on quality of life (13). Uncontrolled acromegaly patients experience a lower life expectancy of 10-15 years and suffer from multimorbidity (14).…”

Section: Introductionmentioning

confidence: 99%

Trans-Sphenoidal Surgery for "Growth Hormone-secreting adenoma; Revisiting Surgical Outcome

Özdemi̇r

Batçık

2021

Middle Black Sea Journal of Health Science

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2014 to May 2021. All patients underwent a microscopic transnasal approach. It was aimed gross total excision of adenoma. For functioning adenomas, hormonal assessment was done on follow-up (8 weeks) and remission was said to be achieved if normal hormonal levels were achieved along with gross total tumor removal. Surgical complications were evaluated, and postoperative follow-up with laboratory and imaging studies were performed. Results: 78 patients were operated by trans nasal route in our hospital between January 2014-June 2021. Of these 78 pituitary tumors, 22 were growth hormone secreting adenoma. The study population consisted of 22 people, 11 men and 11 women, and the average age of the population was calculated as 60.45 years ± 18.4. Statistical analysis showed that the difference between the pre-operative and post-operative somamedine and growth hormone level was statistically significant Conclusions: Microscopic Trans-Sphenoidal Surgery for Acromegalic patients is a minimally invasive, safe, and efficacious choice

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Impact of Experience on Outcomes After Endoscopic Transsphenoidal Surgery for Acromegaly

Cited by 12 publications

References 28 publications

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

Trans-Sphenoidal Surgery for "Growth Hormone-secreting adenoma; Revisiting Surgical Outcome

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