Repeat transsphenoidal surgery for the treatment of remaining or recurring pituitary tumors in acromegaly.
BACKGROUND
Acromegaly is a disorder characterized by hypersecretion of growth hormone caused by a growth hormone-secreting pituitary adenoma.


OBJECTIVE
To evaluate the long-term efficacy and safety of repeat transsphenoidal surgery for persistent or recurrent acromegaly.


METHODS
We retrospectively reviewed records for 53 acromegalic patients who underwent repeat transsphenoidal surgery for persistent or progressive acromegaly at Toranomon Hospital between 1987 and 2006. Multivariate logistic regression was performed to evaluate preoperative factors influencing the surgical outcome.


RESULTS
Thirty-one patients (58.5%) met the criteria for cure on long-term follow-up endocrine findings. Furthermore, 17 patients were well controlled with normal insulin-like growth factor I levels without (2 patients) or with medication (15 patients), whereas insulin-like growth factor I levels were still above normal in 5 patients after postoperative adjuvant therapy. Only 1 patient was undergoing additional hormonal replacement after surgery, although transient cerebrospinal fluid leak, transient abducens nerve palsy, severe nasal bleeding, and pituitary abscess occurred in each patient, respectively. Multivariate analysis clarified that a favorable surgical outcome was achieved in patients without cavernous sinus invasion (hazard ratio 12.56), tumor segmentation (hazard ratio 5.82), or in those older than 40 years old (hazard ratio 3.21).


CONCLUSIONS
Repeat surgery can be performed safely with an approximately 60% long-term cure rate in this series. Reoperation should therefore be considered for persistent or recurrent disease in acromegalic patients in whom adjuvant therapy is not effective enough or cannot be accepted. The careful study of initial or preoperative magnetic resonance imaging and the use of micro-Doppler, endoscope, and eye movement monitoring device during surgery can help increase cure rate with a lower complication rate.
Yamada
Shozo
S
Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, Tokyo Japan. syamadays11@hotmail.com
Fukuhara
Noriaki
N
Oyama
Kenichi
K
Takeshita
Akira
A
Takeuchi
Yasuharu
Y
D000172:Acromegaly / Q000209:etiology* / Q000601:surgery*; D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D013006:Growth Hormone / Q000378:metabolism*; D006801:Humans; D007016:Hypophysectomy / Q000009:adverse effects*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000601:surgery; D010911:Pituitary Neoplasms / Q000150:complications*; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D055502:Secondary Prevention; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D013006:Growth Hormone