Outcome of Surgery for Acromegaly Performed by Different Surgeons: Importance of Surgical Experience

Ertürk, Erdinç; Tuncel, Ercan; Kıyıcı, Sinem; Ersoy, Canan; Duran, Cevdet; İmamoğlu, Şazi

doi:10.1007/s11102-005-3280-9

Cited by 50 publications

(26 citation statements)

References 31 publications

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“…The number of patients from the present cohort treated by these centers ranged from 1 to 110. Experience is a well accepted and important determinant of surgical success and the number of operations might be used as a surrogate parameter (9,41,42). Although the documented cases in the register do not necessarily reflect the total number of pituitary operations performed by each center, there was a significant trend of higher cure rates in centers with more cases.…”

Section: No Of Casesmentioning

confidence: 99%

Long-term outcome in patients with acromegaly: analysis of 1344 patients from the German Acromegaly Register

Schöfl

Franz²,

Grußendorf³

et al. 2013

European Journal of Endocrinology

100

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Background: Acromegaly is a rare disease with significant morbidity and increased mortality. Epidemiological data about therapeutic outcome under 'real life' conditions are scarce. Objective: To describe biochemical long-term outcome of acromegaly patients in Germany. Design and methods: Retrospective data analysis from 1344 patients followed in 42 centers of the German Acromegaly Register. Patients' data were collected 8.6 (range 0-52.6) years after diagnosis. Controlled disease was defined by an IGF1 within the center-specific reference range. Results: Nine hundred and seventeen patients showed a normalized IGF1 (157 (range 25-443) ng/ml). In patients with a diagnosis dated back O2 years (nZ1013), IGF1 was normalized in 76.9%. Of the patients, 19.5% had an elevated IGF1 and a random GH R1 ng/ml, 89% of the patients had at least one surgical intervention, 22% underwent radiotherapy, and 43% received medical treatment. After surgery 38.8% of the patients were controlled without any further therapy. The control rates were higher in surgical centers with a higher caseload (PZ0.034). Of the patients with adjunctive radiotherapy 34.8% had a normal IGF1 8.86 (0-44.9) years post irradiation, 65.2% of the medically treated patients were controlled, and 47.2% of the patients with an elevated IGF1 received no medical therapy. Conclusion: The majority of acromegaly patients were controlled according to their IGF1 status. Longterm outcome could be improved by exploiting medical treatment options especially in patients who are not controlled by surgery and/or radiotherapy.

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Section: No Of Casesmentioning

confidence: 99%

Long-term outcome in patients with acromegaly: analysis of 1344 patients from the German Acromegaly Register

Schöfl

Franz²,

Grußendorf³

et al. 2013

European Journal of Endocrinology

100

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“…These have been based on either single measures or various combinations of random/mean GH day profile levels (often with different cut-off values), nadir GH levels after OGTT and IGF-1 measurements. The results of primary surgery vary between 33% and less in non-specialized centers (16) and up to 70 % and more in specialized centers (29), overall success …”

Section: Discussionmentioning

confidence: 99%

Improvement in remission rates of the first operation in acromegalic patients

Demir¹,

Gedik²,

Çorapçıoğlu³

et al. 2012

Turkish Neurosurgery

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AIm:The aim of the study was to determine the remission rates of the first operation with respect to the number of surgeons and the parameters important for the prediction of the success. mATeRIAL and meTHods:The study cohort consisted of 180 acromegalic patients who presented over a 29 year. All the patients had undergone transnasal transsphenoidal adenomectomy and then octreotide treatment and/or radiotherapy were applied to the patients who were not cured. Remission criteria was accepted as nadir GH<1 µg/L with oral glucose tolerance test (OGTT) and normal IGF-1 with respect to age and gender. ResuLTs:The postoperative median follow up period was 84 months (range 6-372 months). The remission rate of the first operation before 2003 was 20%, but this rate increased to 51% after 2003 (p=0.018). The most impressive improvement was due to the single experienced surgeon (49% vs. 5.3%) (p<0.001). The success of the first operation was determined by the tumor size, microadenomas were more successfully treated than macroadenomas (p=0.014). The prevalence of discordance between GH and IGF-1 was 24% in patients cured after first surgery. CoNCLusIoN:The clinical recognition of acromegaly and outcomes of single experienced surgeons in specialized centers have significantly improved over the last years.KeywoRds: Acromegaly, Transnasal transsphenoidal adenomectomy, Microadenoma, Macroadenoma, Remission rate ÖZ AmAÇ: Akromegali tedavisinde ilk cerrahi tedavinin başarısını, beyin cerrahının deneyimine, sayısına ve remisyon oranlarını etkileyebilecek diğer parametrelere göre belirlemektir. yÖNTem ve GeReÇLeR: 29 yıl süresince 180 akromegalik hasta (86 kadın, 94 erkek) değerlendirilmiştir. Tüm hastalara transnazal/transsfenoidal adenomektomi yapılmış, kür sağlanamayanlara octreotid tedavisi ve/veya radyoterapi uygulanmıştır. Remisyon kriteri olarak, IGF-1'in yaş ve cinsiyete göre normal sınırlarda olması ve Glukoz-büyüme hormonu baskılanma testinde büyüme hormonunun <1'e baskılanması kabul edilmiştir.BuLGuLAR: Postoperatif ortanca (minimum-maksimum) takip süresi 84 (6-372) aydır. İlk operasyonun remisyon oranı 2003'ten önce %20 iken 2003'ten sonra %51'e yükselmiştir (p= 0,018). Oranlardaki en belirgin düzelme, tek deneyimli cerrah ile sağlanmıştır (%49 ve %5,3) (p<0,001). İlk operasyonun başarısı, tümör boyutundan etkilenmektedir. Mikroadenomlar, makroadenomlara göre ilk operasyon sonrası (p= 0,014) daha başarılı bir şekilde tedavi edilmektedir. Büyüme hormonu-IGF-1 diskordansı, ilk cerrahi sonrası kür olanlarda %24 oranında bulunmuştur. soNuÇ: Hipofiz cerrahisinin, referans merkezlerinde tek deneyimli cerrah tarafından yapılması sıkı remisyon kriterleri kullanıldığında bile son yıllarda akromegali tedavisinde önemli gelişmeler sağlanmasına katkıda bulunmuştur.

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“…A importância do tempo de experiência nos resultados da cirurgia hipofisária transesfenoidal na acromegalia tem sido observada em diversos estudos (14)(15)(16)(17). A evolução das taxas de sucesso cirúrgico em 139 pacientes operados por um único cirurgião em 21 anos mostrou que a taxa de remissão subiu de 48% nos primeiros oito anos (1974)(1975)(1976)(1977)(1978)(1979)(1980)(1981) para 73% no último período analisado (1991)(1992)(1993)(1994)(1995).…”

Section: Adenoma Secretor De Tshunclassified

Controle hormonal dos adenomas hipofisários pela cirurgia transesfenoidal: evolução dos resultados nos primeiros cinco anos de experiência

Barbosa

Zymberg

Santos

et al. 2011

Arq Bras Endocrinol Metab

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RESUMOObjetivo: Avaliar os resultados iniciais de uma equipe cirúrgica no controle hormonal dos adenomas hipofisários secretores. Materiais e métodos: Em cinco anos, foram operados 51 adenomas secretores (31 GH, 14 ACTH, 5 prolactina, 1 TSH). O controle hormonal foi GH basal ≤ 2,5 ng/dL, cortisol livre urinário normal, redução dos níveis de prolactina, e T3 e T4 livre normais. Resultados: As taxas de controle foram 36% na acromegalia e 57% no Cushing. Dois prolactinomas (40%) normalizaram a prolactina. Os hormônios tiroidianos normalizaram no adenoma secretor de TSH. O controle do hipercortisolismo correlacionou-se com o tempo de experiência da equipe (p = 0,01). Conclusão: Nossos resultados, limitados aos primeiros anos de experiência cirúrgica, situam-se abaixo da variação reportada em grandes casuísticas com maior tempo de experiência. Ao longo do tempo, observou-se melhora progressiva nos níveis de cortisol urinário no pós-operatório inicial da doença de Cushing em função da experiência cirúrgica. Arq Bras Endocrinol Metab. 2011;55(1):16-28 Descritores Cirurgia transesfenoidal; adenoma hipofisário; doença de Cushing; acromegalia; prolactinoma ABSTRACT Objective: To evaluate the initial results of a surgical team in the hormonal control of secreting pituitary adenomas. Materials and methods: In five years 51 functioning adenomas were operated (31 GH-secreting, 14 ACTH-secreting, 5 PRL-secreting and 1 TSH-secreting). Hormonal control was defined as GH ≤ 2,5 ng/mL, normal free-urinary cortisol, lower prolactin and normal T3 and FT4. Results: Control rates were 36% in acromegaly, and 57% in Cushing's disease. Two prolactinomas normalized prolactin levels. Thyroid hormone levels were normalized in the TSH--secreting adenoma. Control of hypercortisolism was positively correlated with years of experience (p = 0.01). Conclusion: Our results, although restricted to the beginning of our experience, lie below the reported range of other surgical series with much longer experience. During these years, there was a significant improvement in initial post surgery urinary cortisol levels in Cushing's disease as a function of surgical experience. Arq Bras Endocrinol Metab. 2011;55(1):16-28

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Outcome of Surgery for Acromegaly Performed by Different Surgeons: Importance of Surgical Experience

Cited by 50 publications

References 31 publications

Long-term outcome in patients with acromegaly: analysis of 1344 patients from the German Acromegaly Register

Long-term outcome in patients with acromegaly: analysis of 1344 patients from the German Acromegaly Register

Improvement in remission rates of the first operation in acromegalic patients

Controle hormonal dos adenomas hipofisários pela cirurgia transesfenoidal: evolução dos resultados nos primeiros cinco anos de experiência

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