Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

Abstract

IntroductionIt is unclear whether the proportions of remission and the recurrence rates differ between endoscopic transsphenoidal surgery (TS) and microscopic TS in Cushing’s disease (CD); thus, we conducted a systematic review and meta-analysis to evaluate studies of endoscopic TS and microscopic TS.MethodsWe conducted a comprehensive search of PubMed to identify relevant studies. Remission and recurrence were used as outcome measures following surgical treatment of CD.ResultsA total of 24 cohort studies involving 1670 adult patients were included in the comparison. Among these studies, 702 patients across 9 studies underwent endoscopic TS, and 968 patients across 15 studies underwent microscopic TS. Similar baseline characteristics were observed in both groups. There was no significant difference in remission between the two groups: 79.7% (95% CI: 73.1–85.0%) in the endoscopic group and 76.9% (95% CI: 71.3–81.6%) in the microscopic group (P = 0.485). It appears that patients who underwent endoscopic surgery experience recurrence less often than patients who underwent microscopic surgery, with recurrence proportions of 11.0% and 15.9%, respectively (P = 0.134). However, if follow-up time is taken into account, both groups had a recurrence rate of approximately 4% per person per year (95% CI: 3.1–5.4% and 3.6–5.1%, P = 0.651).ConclusionsWe found that remission proportion and recurrence rate were the same in patients who underwent endoscopic TS as in patients who underwent microscopic TS. The definition of diagnosis, remission and recurrence should always be considered in the studies assessing therapeutic efficacy in CD.

Cushing's disease in older patients: Presentation and outcome

“…Postoperative remission rates vary widely in the literature, depending on the adopted remission criteria, ranging from 65% to 93%. 15 In our study, no significant difference was observed in initial remission rate, remission rate after early second operation and overall remission between the two age groups.…”

“…Our data showed that the surgical remission rates were similar in both younger and older populations and that surgery remains safe and effective in older age group. Postoperative remission rates vary widely in the literature, depending on the adopted remission criteria, ranging from 65% to 93% . In our study, no significant difference was observed in initial remission rate, remission rate after early second operation and overall remission between the two age groups.…”

“…In our study, no significant difference was observed in initial remission rate, remission rate after early second operation and overall remission between the two age groups. In a recent meta‐analysis, remission rate was around 78% in CD patients . Early reoperation remains a successful treatment strategy in older patients, with reasonably high remission rates.…”

“…Postoperative serum cortisol, UFC and LNSC were classified as consistent with: (a) remission, which was defined as the presence of low early morning serum cortisol concentrations (<138 nmol/L), or low 24‐hour UFC levels (<55 nmol/24 h), or (b) persistent disease, defined as either normal or elevated postoperative serum cortisol levels or elevated 24‐hour UFC. Recurrence was defined as representation with an elevated 24‐hour UFC, inability to suppress serum cortisol after low‐dose dexamethasone testing, elevated serum cortisol concentration, or elevated LNSC with clinical symptoms after initial remission . Data on adjunctive treatments, including radiation therapy to the sella, medical therapy and bilateral adrenalectomy were also recorded in patients with persistent/recurrent disease.…”

“…If tumour was not identified intraoperatively, we usually did hemi-hypophysectomy. We recorded data from pathology reports documenting the presence of ACTH- [15][16][17] Data on adjunctive treatments, including radiation therapy to the sella, medical therapy and bilateral adrenalectomy were also recorded in patients with persistent/recurrent disease.…”