Turkish neurosurgery · 2012
Improvement in remission rates of the first operation in acromegalic patients.
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Demir Ozgur, Gedik Vedia, Corapcioglu Demet, Emral Rifat, Unlu Mustafa Agahan, Erdogan Murat Faik, Gullu Sevim, Uysal Ali Riza, Baskal Nilgun
Аннотация
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.
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.
Предметные рубрики MeSH
AcromegalyAdultAntineoplastic Agents, HormonalFemaleGlucose Tolerance TestHuman Growth HormoneHumansInsulin-Like Growth Factor IMaleMiddle AgedNeurosurgical ProceduresOctreotidePituitary GlandPituitary HormonesPituitary NeoplasmsPostoperative ComplicationsPrognosisRetrospective StudiesTreatment OutcomeYoung Adult