Abstract
Biochemical remission after transsphenoidal surgery is still unsatisfied in acromegaly patients with macroadenomas, especially with invasive macroadenomas. Concerning the impact of preoperative somatostatin analogues (SSAs) on surgical outcomes, previous studies with limited cases reported conflicting results. To assess current evidence of preoperative medical treatment, we performed a systematic review and meta-analysis of comparative studies. A literature search was conducted in Pubmed, Embase, and the Cochrane Library. Five randomized controlled trials (RCT) and seven non-RCT comparative studies were included. These studies mainly focused on pituitary macroadenomas though a small number of microadenoma cases were included. For safety, preoperative SSAs were not associated with elevated risks of postoperative complications. With respect to efficacy, the short-term cure rate was improved by preoperative SSAs, but the long-term cure rate showed no significant improvement. For invasive macroadenomas, the short-term cure rate was also improved, but the long-term results were not evaluable in clinical practice because adjuvant therapy was generally required. In conclusion, preoperative SSAs are safe in patients with acromegaly, and the favorable impact on surgical results is restricted to the short-term cure rate in macroadenomas and invasive macroadenomas. Further well-designed RCTs to examine long-term results are awaited to update the finding of this meta-analysis.
Highlights
Biochemical remission after transsphenoidal surgery is still unsatisfied in acromegaly patients with macroadenomas, especially with invasive macroadenomas
The impact of preoperative medical treatment on the long-term results has not been well demonstrated. It remains uncertain whether preoperative medical treatment can benefit the invasive growth hormone (GH)-secreting pituitary adenomas in terms of short- and long-term biochemical remission
We performed a systematic review and meta-analysis of comparative studies to evaluate the impact of preoperative somatostatin analogues (SSAs) on the surgical results and postoperative complications based on the updated evidence
Summary
Biochemical remission after transsphenoidal surgery is still unsatisfied in acromegaly patients with macroadenomas, especially with invasive macroadenomas. Preoperative SSAs are safe in patients with acromegaly, and the favorable impact on surgical results is restricted to the short-term cure rate in macroadenomas and invasive macroadenomas. Www.nature.com/scientificreports studies with relatively small sample sizes have shown conflicting results regarding the benefit of preoperative SSAs. SSAs were not recommended for routine use in acromegaly before pituitary surgery[5]. The impact of preoperative medical treatment on the long-term results has not been well demonstrated It remains uncertain whether preoperative medical treatment can benefit the invasive GH-secreting pituitary adenomas in terms of short- and long-term biochemical remission. We performed a systematic review and meta-analysis of comparative studies to evaluate the impact of preoperative SSAs on the surgical results and postoperative complications based on the updated evidence
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