Postoperative Diabetes Research Articles

Giant and irregular pituitary neuroendocrine tumors surgery: comparison of simultaneous combined endoscopic endonasal and transcranial and purely endoscopic endonasal surgery at a single center

BackgroundSurgical management of giant and irregular pituitary neuroendocrine tumors (GIPitNETs) presents a significant challenge in neurosurgery. While endoscopic endonasal surgery (EES) is a widely used approach for PitNETs, GIPitNETs with extensive intracranial extension pose challenges for purely EES. We use simultaneous combined endoscopic endonasal and transcranial surgery (CECS) for the treatment of this type of tumor. Currently, there is limited research comparing CECS to EES for GIPitNETs. This study aims to compare the efficacy and short outcome of CECS and purely EES in the management of GIPitNETs to better understand the advantages and limitations of each surgical approach.MethodsThe data of GIPitNETs patients who underwent surgery between March 2018 and May 2023 at a single center were retrospectively reviewed. All included cases were divided into CECS and EES groups according to the treatment modality received. The baseline characteristics and tumor imaging features of patients were compared between the groups, as well as surgical results, perioperative complications, and last follow-up outcomes.ResultsA total of 50 patients met the inclusion criteria, with 27 undergoing CECS and 23 EES. CECS achieved a significantly higher GTR rate compared to EES (66.7% vs. 13.0%, p < 0.0001). CECS had longer operation times and hospital stays, but both approaches had similar rates of complications, including intracranial infection, CSF leakage, new pituitary dysfunction, postoperative diabetes insipidus, and vascular infarction. CECS reduces the risk of postoperative bleeding. Tumor recurrence and reoperation were significantly more common in the EES group.ConclusionsCECS is a safe and effective surgical approach for GIPitNETs, leading to higher rates of GTR, comparable complication rates, and reduced risk of postoperative bleeding when compared to purely EES. EES was associated with more tumor recurrence. Further long-term follow-up data is needed to validate these findings.

Effectiveness of Roux-en-Y Gastric Bypass in Patients with Type 2 Diabetes: A Meta-analysis of Randomized Controlled Trials.

This meta-analysis aimed to evaluate the effectiveness of Roux-en-Y gastric bypass (RYGB) in people living with type 2 diabetes mellitus (T2DM). A comprehensive search was conducted in the PubMed database up to January 2024. A random-effects model was used to calculate the pooled standard mean differences (SMDs) and odds ratios (ORs). Ten studies were included in our review. The RYGB group demonstrated significantly better outcomes compared to the non-surgical group in multiple measures. These included higher triple criteria compliance rates (OR 9.04, 95% CI 3.22-25.36), complete T2DM remission (OR 15.37, 95% CI 4.42-53.41), and partial T2DM remission (OR 11.49, 95% CI 3.57-37.03). Additionally, improvements were observed in glycated hemoglobin A1c (HbA1c) levels (SMD - 1.41, 95% CI - 2.22 to - 0.61), with HbA1c < 6.0% (OR 8.54, 95% CI 3.38-21.62) and HbA1c < 7.0% (OR 5.62, 95% CI 3.20-9.86). Fasting blood glucose (FBG) levels also showed improvement (SMD - 0.43, 95% CI - 0.71 to - 0.14), with a higher proportion achieving FBG < 100mg/dl (OR 11.83, 95% CI 4.75-29.43). Other notable outcomes included significant percentage of total weight loss (%TWL: SMD 1.88, 95% CI 1.39-2.37), reductions in body mass index (BMI: SMD - 2.28, 95% CI - 3.52 to - 1.04), and improvements in lipid profiles, including low-density lipoprotein (LDL) levels (SMD - 1.01, 95% CI - 1.91 to - 0.11) and LDL < 2.59mmol/L (OR 3.65, 95% CI 1.94-6.87). In addition, high-density lipoprotein (HDL) levels increased (SMD 1.30, 95% CI 0.55-2.05), while triglycerides (SMD - 1.11, 95% CI - 1.70 to - 0.52), systolic blood pressure (SBP: SMD - 0.38, 95% CI - 0.70 to - 0.06), and diastolic blood pressure (DBP: SMD - 0.41, 95% CI - 0.63 to - 0.18) decreased. A greater proportion of patients in the RYGB group achieved SBP < 130mmHg (OR 3.15, 95% CI 1.61-6.13). Moreover, reductions were noted in insulin use (OR 0.25, 95% CI 0.14-0.46), diabetes medication use (SMD - 1.95, 95% CI - 3.32 to - 0.57), and peripheral neuropathy (OR 0.13, 95% CI 0.02-0.79). However, no significant differences were observed in hypertension medication use or retinopathy between the two groups. RYGB was found to be effective in improving glycemic control, promoting weight loss, enhancing lipid profiles, and managing blood pressure. It also significantly reduced the need for postoperative diabetes medications and the incidence of diabetic peripheral neuropathy in people living with T2DM.

Bibliometric study and visual analysis of postoperative diabetes mellitus in kidney transplant recipients based on WoSCC database

Background In recent years, the increase of the post-transplantation diabetes mellitus (PTDM) after renal transplantation encourages people to do a lot of research on the disease. This paper conducted a bibliometric study on PTDM related literature to explore the risk factors of diabetes after kidney transplantation, as well as the current status, hotspots and development trends of PTDM research, so as to provide reference for researchers in related fields. Methods We searched the Web of Science Core Collection (WoSCC) database for PTDM literature from January 1, 1990, to August 20, 2023, and used VOSviewer, CiteSpace, and the R package ‘bibliometrix’ to do bibliometric analysis. Results Obesity, 3 months after transplantation tacrolimus concentration >10 ng/mL, temporary hyperglycemia, delayed graft function, acute rejection is specific risk factors related to PTDM in renal transplant recipients. In addition, 74 countries led by China and the United States published 1546 papers, and the number of PTDM-related publications is increasing every year. Primary institutions included the University of California, Los Angeles, Mayo Clinic, University of Oslo, and University of Toronto. The Journal of Transplantation is the most widely read journal in the subject. The authors with the most published literature are Trond Jenssen and Adnan Sharif, and the most cited author is Kasiske BL. Expectations for continued growth in global PTDM research are increasingly high. Future studies will mainly focus on exploring the risk factors of PTDM and identifying new therapeutic approaches and targets.

Nomogram for predicting diabetes insipidus following endoscopic transsphenoidal surgery in pituitary adenomas.

Postoperative diabetes insipidus (DI) frequently complicates endoscopic transsphenoidal surgery (TSS) in pituitary adenoma (PA) patients, yet reliable predictive methods for DI risk remain lacking. This study aims to identify risk factors associated with DI following endoscopic transsphenoidal resection of PA and to develop a predictive nomogram for assessing postoperative DI risk. This study involved 600 PA patients underwent endoscopic TSS at Shandong Provincial Hospital from 2021 to 2023. Among these patients, 82 developed postoperative DI while 518 did not. The cohort was randomly divided into training (n = 360) and validation (n = 240) groups at 6:4 ratios by R software. Clinical parameters and radiographic features were evaluated using univariable and multivariable logistic regression to construct a predictive nomogram for post-endoscopic TSS DI risk. Model performance was assessed using ROC curves, calibration plots, and decision curve analysis. Subgroup analysis was used to evaluate the model's ability to discriminate between transient and permanent DI. Univariable and multivariable logistic regression analyses on the training group identified several independent risk factors for post-endoscopic TSS DI, including maximum tumor diameter, Knosp grade, Esposito grade, recurrent PA, and pituitary stalk deviation angle. A nomogram was developed based on these factors, demonstrating robust predictive accuracy with ROC areas under curve of 0.840 for the training group and 0.815 for the validation group. Calibration plots indicated excellent agreement between predicted and observed probabilities of postoperative DI. DCA curves highlighted the nomogram's efficacy in guiding clinical decision-making. Subgroup analysis showed that the model was able to discriminate between transient and permanent DI, and the AUC was 0.652 (95% CI 0.525-0.794). This study presents a nomogram designed to predict postoperative DI risk in patients undergoing endoscopic TSS for PA. Internal and external validations underscored the model's high accuracy, calibration, and clinical utility. Simultaneously, the model can also assess the development risk of permanent DI. This predictive tool offers clinicians valuable support in identifying high-risk DI patients, optimizing postoperative care strategies, and tailoring treatment plans to improve patient outcomes.

COMPLEXITY OF PITUITARY ADENOMA SURGERY

Introduction Pituitary adenomas are the most common intraselllar tumors, representing 16% of all intracranial lesions. Although the symptomatology is very complex, it requires a multimodal treatment plan, in order to cover all corners of this combined pathology. Mostly the treatment is surgical, hormonal or combined. The transnazosphenoidal corridor offers a optimal visualitation of the anatomic location (via microscope or endoscope) but also comes with a variety of morbidities, one of the most important being the cerebrospinalfluid fistula (CSF leak). Objective We effectuated a retrospective cohort study in which we included patients with pituitary adenoma who were operated in the Clinic of Neurosurgery from Targu-Mures Emergency County Hospital between January 2018 and April 2024 with full documentation, including complications (apoplexy, infections, CSF fistula etc.). Results A total of 45 patients passed the inclusion criteria with a predominance of female patients (60%, n=27) with a mean age of 55.77 years. Analizing the clinical and paraclinical data, there were 39 patients with macroadenoma (vs. microadenoma n=6), with the dominant symptomatology being headache (86.66%) and visual disturbances (66.66%). In 32 cases the transnazosphenoidal (TSS) approach was used (1 case endoscopic and 31 cases microscopic), in 10 cases pure transcranian with modified pterional or subfrontal craniotomy and in 3 cases there was a combined approach. Postoperative complications were encountered in 8 cases (17.77%), and death in 1 case. 6 patients presented postoperative CSF fistula. In 16 cases we encountered postoperative Diabetes Insipidus with a significant difference in the tumor volume favoring this manifestation (p=0.0001). There was no significance found between the volume of the tumor and postoperative CSF leak (p=0.665). In 31 cases (68.88%) the TSS approach was used and the closing of the sphenoid sinus and cranial base was effectuated in a classic manner with fat, fascia and muscle; in additional cases specified glues were used. Conclusions Our study wants to reflect on the importance of anterior/middle cranial base closure, taking into account the possible postoperative complications. It is important to be aware of the technique of different nasoseptal flaps in order to prevent CSF fistula and reduce postoperative complications.

Clinical parameters and postoperative outcomes of pituitary adenomas in children: Analysis according to size of adenomas and adopted surgical procedures.

Pathologies of pediatric pituitary adenomas are uncommon and challenging to diagnose. Pituitary adenomas cause mass effects and neurological disruption in children. Postoperative evaluations of endocrine functions are challenging. The present study categorized adenomas by size and type, and evaluated outcomes based on the surgical procedures adopted. In addition, the present study analyzed the demographic parameters of children as well as the factors supposed to be influencing remission. Clinical characteristics, treatment parameters and postoperative outcomes of curative surgeries in 135 children [80 (59%) females and 55 (41%) males; age 12 (11-13) years at the time of first diagnosis] with pituitary adenomas who underwent curative surgeries operated between 1998 and 2023 in the Yichang Central People's Hospital, (Yichang, China) were included in the present retrospective study. A total of 112 (83%) children had microadenomas (<10 mm adenomas), 6 (4%) had macroadenomas (≥10 mm adenomas) and 17 (13%) had invisible adenomas. Pathological examination revealed that 59 (44%) children had functional adenomas and 10 (7%) had non-functional adenomas. Among functional adenomas, acromegaly (excess secretion of insulin-like growth factor 1) was reported to be the most common [30 (22%)] pediatric adenomas, followed by prolactinomas [prolactin secretion ≥1,000 mIU/l; 20 (15%) and Cushing syndrome (9 (7%)]. A total of 23 (17%), 3 (2%), 4 (3%), 3 (2%) and 3 (2%) children were reported to have remission and underwent re-surgery. These patients (remission) underwent microscopic trans-sphenoidal resection, endoscopic endonasal trans-sphenoidal resection, trans-sphenoidal resection alone, bilateral adrenalectomy and gross total resection adopted curative surgeries initially, respectively. Postoperative diabetes insipidus, adrenal insufficiency and cerebrospinal fluid leaks have been reported in children who have undergone curative surgeries for macroadenomas or Cushing syndrome. Female pediatric patients with clinical manifestations were more likely to have pituitary adenomas. Pediatric patients generally have functional pituitary adenomas, particularly adreno-corticotropin-secreting adenomas. Microscopic trans-sphenoidal resection is associated with a lower risk of under-treatment. Postoperative outcomes and clinical benefits of curative surgeries are based on the complete type of surgical removal and size of the pituitary adenomas mass (Level of Evidence: 3; Technical Efficacy Stage: 4).

Analysis of factors influencing the occurrence of diabetes insipidus following neuroendoscopic transsphenoidal resection of pituitary adenomas and risk assessment

ObjectiveStudies have revealed a higher prevalence of diabetes insipidus in patients following resection of pituitary adenoma surgery. By comprehensively analysing the clinical history of patients undergoing endoscopic transnasal sphenoidal resection for pituitary adenomas, the factors influencing development of postoperative diabetes insipidus were investigated and a predictive model was developed to assess its risk. MethodsA retrospective analysis was conducted on the medical records of 281 patients with pituitary adenomas who underwent neuroendoscopic transsphenoidal resection at our institution between October 2020 and October 2022. The Mann-Whitney U test, chi-square test, and logistic regression analysis were used to identify the independent factors that potentially contribute to the development of postoperative diabetes insipidus. Additionally, a nomogram was constructed to evaluate the predicted risk of postoperative diabetes insipidus in patients with pituitary adenomas. ResultsDiabetes insipidus occurred in 100 (35.59 %) of the 281 enrolled patients. The results of the multifactorial logistic regression analysis revealed that diabetes, hypertension, cardiopathy, preoperative serum cortisol level, cerebrospinal fluid leakage, and tumour texture independently influenced the occurrence of postoperative diabetes insipidus (P < 0.05). A nomogram was developed to evaluate the risk of postoperative diabetes insipidus in patients with pituitary adenoma. ConclusionsMultiple independent risk factors associated with the patient and tumour were identified in predicting diabetes insipidus. Early recognition of these risk factors may contribute to the prevention or reduction of diabetes insipidus incidence following pituitary adenoma surgery.

Effect of pituitary stalk preservation during craniopharyngioma removal on pituitary function, extent of resection, and recurrence: systematic review and meta-analysis.

Optimal management of the pituitary stalk during craniopharyngioma resection remains a controversial subject. This meta-analysis aimed to evaluate the effect of pituitary stalk preservation on postoperative diabetes insipidus (DI), anterior pituitary function (PF), extent of resection, and recurrence. Medline was searched via Ovid for relevant articles from inception to September 2, 2022. Studies reporting the rates of DI or anterior PF postoperatively or at last follow-up, extent of resection, or tumor recurrence at last follow-up were eligible for inclusion. The risk ratio (RR) for each outcome was calculated. Random-effects meta-analyses were performed with additional stratification by age. To assess for risk of bias across studies, funnel plots and the Egger's test were utilized. In total, 3488 abstracts and 150 full-text articles were reviewed, resulting in 33 studies with a total of 2366 patients for inclusion. In the comparative meta-analysis, pituitary stalk preservation significantly decreased the risk of DI postoperatively (17 studies, RR 0.67, 95% CI 0.55-0.81, I2 = 75%), DI at last follow-up (6 studies, RR 0.54, 95% CI 0.41-0.72, I2 = 20%), and abnormal anterior PF postoperatively (15 studies, RR 0.78, 95% CI 0.69-0.89, I2 = 49%) but not abnormal anterior PF at last follow-up (4 studies, RR 0.38, 95% CI 0.09-1.63, I2 = 64%). There were no significant differences in the rates of incomplete resection (12 studies, RR 1.59, 95% CI 0.77-3.28, I2 = 68%) or tumor recurrence (9 studies, RR 1.18, 95% CI 0.92-1.51, I2 = 0%) between the preservation and sacrifice groups. However, subgroup analysis of pediatric patients revealed a higher risk of incomplete resection (RR 3.29, 95% CI 1.17-9.26, I2 = 70%) in the stalk preservation group. Pituitary stalk preservation was demonstrated to confer protective benefit on PF, although the benefit persisted on long-term follow-up for posterior PF only. Stalk preservation in pediatric patients should be given careful consideration, as it is associated with higher rates of incomplete resection. These results should be interpreted with caution due to inclusion of small studies and inadequate reporting of outcomes in the literature.

Robotic Central Pancreatectomy

Central pancreatectomy is an excellent alternative to left pancreatectomy for symptomatic benign or premalignant lesions of the pancreatic body or tail. A key advantage of this technique lies in the preservation of pancreatic parenchyma, resulting in a lower rate of postoperative diabetes mellitus. However, this procedure requires more complex reconstruction, which in turn is associated with an increased risk of morbidity.Insulinoma in the pancreatic body.Robot-assisted central pancreatectomy with pancreaticojejunostomy using a modified Blumgart technique.Central pancreatectomy is a generally rare and challenging pancreatic procedure, but clearly plays a significant role in modern pancreatic surgery due to its functional advantages. When appropriate and technically feasible, central pancreatectomy should be preferred to the alternative of left pancreatectomy and whenever possible, performed minimally invasively.

Cost-effectiveness of Operative Intervention for Mucinous Cystic Neoplasm: The Role of Postoperative Diabetes.

Small mucinous cystic neoplasms (MCNs) of the pancreas are managed with operative resection in otherwise healthy patients; however, postoperative diabetes development is not considered in recommendations for resection. Via probabilistic microsimulation Markov modeling, we assessed clinical and economic implications of laparoscopic distal pancreatectomy (LDP) versus surveillance for non-diabetes mellitus (DM) patients with suspected MCN of 2 cm without high-risk or worrisome features. Primary outcomes included quality-adjusted life years (QALYs), medical costs (2021 USD), and incremental cost-effectiveness ratios. We conducted sensitivity analyses to evaluate the robustness of our model to changes in input parameters. All analyses were repeated for a population with pre-DM. Surveillance resulted in 6.52 QALYs and $61,200, while LDP accumulated 6.12 QALYs and $63,700. Almost 20% of the LDP cohort developed DM over the first 10 years, compared with 11% of the surveillance cohort. In a pre-DM cohort, LDP remained dominated in the base case, with over 40% developing DM postoperatively. In sensitivity analyses, surveillance remained the preferred strategy in most iterations for both cohorts. Surveillance for small suspected MCNs without high-risk features is the preferred strategy from a clinical and economic standpoint. Consensus guidelines should consider the long-term implications of postoperative diabetes development after LDP.

Predictive Factors and Scoring System for Delayed Symptomatic Hyponatremia Following Endoscopic Endonasal Surgery: A Single-Center Retrospective Study

BackgroundsDelayed symptomatic hyponatremia (DSH) is one of the common complications following endoscopic endonasal surgery (EES). Currently, published studies have predominantly focused on delayed postoperative hyponatremia, while there is relatively limited research on DSH. MethodsWe analyzed 175 consecutive cases from a single center between 2019 and 2023, involving patients who underwent endoscopic endonasal surgery (EES) for pituitary adenoma or Rathke's cleft cyst (RCC), all histopathologically confirmed. We collected preoperative, intraoperative, and postoperative data, and performed statistical analysis to determine the incidence of postoperative diabetes insipidus (DI) and identify significant predictive factors. Based on these factors, we developed a simplified scoring system. ResultsThere were 29 cases (16.6%) of DSH occurrence. In the binary logistic regression analysis, Knosp grade ≥3 (OR, 4.19; 95% CI, 1.26-13.92; P=0.019), intraoperative cerebrospinal fluid leaks (OR, 3.93; 95% CI, 1.49-10.34; P=0.006), serum sodium on the second day after surgery (OR, 0.88; 95% CI, 0.78-1.00; P=0.049), and postoperative diabetes insipidus (OR, 2.88; 95% CI, 1.10-7.53; P=0.031) were factors with independent predictive value for DSH. The scoring system achieved a maximum area under the ROC curve (AUC) of 0.789 (95% CI, 0.697-0.881), with a cutoff value of 1, sensitivity of 86.2%, and specificity of 59.6%. ConclusionThe incidence rate of DSH after EES in patients was 16.8%. Knosp grade ≥3, intraoperative cerebrospinal fluid leaks, serum sodium concentration on the second day after surgery, and postoperative diabetes insipidus were associated with the occurrence of DSH.

Incidence of Postoperative Diabetes Mellitus After Roux-en-Y Reconstruction for Gastric Cancer: Retrospective Single-Center Cohort Study.

Sleeve gastrectomy is an effective surgical option for morbid obesity, and it improves glucose homeostasis. In patients with gastric cancer and type 2 diabetes mellitus (DM), gastrectomy, including total gastrectomy, is beneficial for glycemic control. This study aims to clarify the effects of gastrectomy and different reconstructive techniques on the incidence of postoperative DM in patients with gastric cancer. This retrospective, single-center, cohort study included 715 patients without DM who underwent total gastrectomy at the Tokyo Metropolitan Bokutoh Hospital between August 2005 and March 2019. Patients underwent reconstruction by Roux-en-Y (RY) gastric bypass or other surgical techniques (OT), with DM onset determined by hemoglobin A1c levels or medical records. Analyses included 2-sample, 2-tailed t tests; χ2 tests; and the Kaplan-Meier method with log-rank tests to compare the onset curves between the RY and OT groups, along with additional curves stratified by sex. A Swimmer plot for censoring and new-onset DM was implemented. Stratified data analysis compared the RY and OT reconstruction methods. The hazard ratio was 1.52 (95% CI 1.06-2.18; P=.02), which indicated a statistically significant difference in the incidence of new-onset diabetes between the RY and OT groups in patients with gastric cancer. The hazard ratio after propensity score matching was 1.42 (95% CI 1.09-1.86; P=.009). This first-of-its-kind study provides insight into how different methods of gastric reconstruction affect postoperative diabetes. The results suggest significant differences in new-onset DM after surgery based on the reconstruction method. This research highlights the need for careful surgical planning to consider potential postoperative DM, particularly in patients with a family history of DM. Future studies should investigate the role of gut microbiota and other reconstructive techniques, such as laparoscopic jejunal interposition, in developing postoperative DM.

Peer Review of "Incidence of Postoperative Diabetes Mellitus After Roux-en-Y Reconstruction for Gastric Cancer: Retrospective Single-Center Cohort Study".

Peer Review of "Incidence of Postoperative Diabetes Mellitus After Roux-en-Y Reconstruction for Gastric Cancer: Retrospective Single-Center Cohort Study".

Author's Response to Peer Reviews of "Incidence of Postoperative Diabetes Mellitus After Roux-en-Y Reconstruction for Gastric Cancer: Retrospective Single-Center Cohort Study".

Author's Response to Peer Reviews of "Incidence of Postoperative Diabetes Mellitus After Roux-en-Y Reconstruction for Gastric Cancer: Retrospective Single-Center Cohort Study".

Impacts of different pancreatic resection ranges on endocrine function in Suncus murinus.

Surgical intervention involving the pancreas can lead to impaired glucose tolerance and other types of endocrine dysfunction. The scope of pancreatectomy and whether it includes the ventral pancreas are the key factors in the development of postoperative diabetes. The ventral and dorsal pancreases are almost separated in Suncus murinus (S. murinus). To investigate the effects of different extents of pancreatic resection on endocrine function in S. murinus. Eight-week-old male S. murinus shrews were randomly divided into three experimental groups according to different pancreatic resection ranges as follows: ventral pancreatectomy (VPx) group; partial pancreatectomy (PPx) group; subtotal pancreatectomy (SPx) group; and a sham-operated group. Postprandial serum insulin, glucagon-like peptide-1 (GLP-1), pancreatic polypeptide (PP), and somatostatin (SST) levels, as well as food intake, weight, blood glucose, and glucose tolerance were regularly measured for each animal. S. murinus treated with PPx and SPx suffered from varying degrees of impaired glucose tolerance, but only a small proportion of the SPx group developed diabetes. Only S. murinus in the SPx group showed a significant decrease in food intake accompanied by severe weight loss, as well as a significant increase in postprandial serum GLP-1 levels. Postprandial serum PP levels decreased in both the VPx and PPx groups, but not in the SPx group. Postprandial serum SST levels decreased in both VPx and PPx groups, but the decrease was marginal. Severe weight loss after pancreatectomy may be related to loss of appetite caused by compensatory elevation of GLP-1. PP and GLP-1 may play a role in resisting blood glucose imbalance.

Surgical outcome of endoscopic endonasal approach as a modality of management for large and giant pituitary adenomas: a retrospective case series

BackgroundLarge and giant pituitary adenomas (defined as tumors of maximal diameter ≥ 3–3.9 cm and ≥ 4 cm, respectively) present considerable surgical challenges regarding the extent of resection and perioperative morbidity. Endoscopic endonasal resection is considered the most effective treatment for pituitary adenomas. It allows for better visualization, maneuverability, and access to distant and lateral tumor compartments, ultimately enhancing the extent of resection. This article evaluates our initial experience with endoscopic endonasal resection of large and giant pituitary adenomas. The clinical outcomes, perioperative complications, and extent of tumor resection would be specifically addressed.Patients and methodsThe primary goal of surgery was to decompress the optic pathways, and the secondary goals were to achieve maximal safe resection and hormonal control in hormone-secreting adenomas. The degree of tumor resection was classified as gross-total resection (100%), near-total resection (90–100%), subtotal resection (70–90%), and partial resection (< 70%).Results42 patients were included in this study. A good visual outcome achieved with 80% improvement in visual symptoms. Gross-total resection (GTR) was achieved in 19 patients (45.2%), near-total resection (NTR) was achieved in 12 patients (28.6%), subtotal resection (STR) in 6 patients (14.3%), and partial resection in the remaining 5 patients (11.9%). Subgroup analysis revealed that GTR, NTR rates were higher in large, compared to giant tumors. GTR, NTR rates of large adenomas were 59.3%, and 29.6%, compared to 20%, and 26.7% in giant adenomas respectively (p-value: 0.01428). Surgical complications were observed in 19 patients (45.2%) with CSF leakage being the most common complication (11 patients, 26.2%). Post-operative diabetes insipidus was observed in 5 patients (11.9%), major vascular injury in one case (2.4%), transient post-op 6th nerve palsy observed in 3 patients (7.1%), while two patients (4.8%) presented with post-operative paranasal sinuses infection.ConclusionsEndoscopic endonasal transsphenoidal resection of large and giant pituitary adenomas is a safe and efficient procedure. Large adenomas (3–3.9 cm) have excellent resection rates and lower complications than giant adenomas (≥ 4 cm), which may require extending our approach to achieve more tumor resection rates in the future. However, only adequate resection of these giant adenomas can be enough to achieve the main surgical goals of visual improvement, hormonal control, and decompression of surrounding structures.

Association between eating behavior and post-operative diabetes mellitus remission

Association between eating behavior and post-operative diabetes mellitus remission

The effect of preoperative TSH levels on perioperative complications in patients undergoing pituitary surgery

IntroductionPituitary surgery involves special conditions for the anaesthetist due to the anatomical localisation and the role of the pituitary gland in hormonal balance. The aim of this study was to retrospectively investigate the effect of TSH levels on perioperative complication rates in patients undergoing pituitary surgery.MethodsIn this study, patients who underwent pituitary surgery at Izmir Katip Celebi University Ataturk Training and Research Hospital between January 2017 and November 2022 were retrospectively screened. Two patients out of the 137 were excluded from the study as they underwent simultaneous aneurysm surgery along with pituitary tumor surgery. A total of 135 patients meeting the criteria were analyzed. Patients were divided into three groups according to TSH levels. Perioperative complication rates and mortality rates were compared between the three groups.FindingsThe study included a total of 135 patients, with an age range of 16–76 years. Among the groups with low–normal–high TSH levels, there were no statistically significant difference observed, in postoperative complications, such as epistaxis, rhinorrhea, postoperative nausea/vomiting, seizures, hypertension, and hypotension. When looking at the incidence of postoperative diabetes insipidus, a significant difference was found between the groups. When examining the mortality rates on the 28th day, a significant difference was found between the groups, with a mortality rate of 25% in the high TSH group (p < 0.5).ConclusionsThe risk of perioperative mortality is higher in patients with TSH levels above normal.

Association Between Hypotension During Pancreatectomy and Development of Postoperative Diabetes.

With advancements in long-term survival after pancreatectomy, postpancreatectomy diabetes has become a concern, and the risk factors are not yet established. Pancreatic islets are susceptible to ischemic damage, though there is a lack of clinical evidence regarding glycemic deterioration. To investigate association between hypotension during pancreatectomy and development of postpancreatectomy diabetes. In this retrospective, longitudinal cohort study, we enrolled patients without diabetes who underwent distal pancreatectomy or pancreaticoduodenectomy between January 2005 and December 2018 from 2 referral hospitals in Korea. Intraoperative hypotension (IOH) was defined as a 20% or greater reduction in systolic blood pressure. The primary and secondary outcomes were incident diabetes and postoperative Homeostatic Model Assessment (HOMA) indices. We enrolled 1129 patients (average age, 59 years; 49% men; 35% distal pancreatectomy). IOH occurred in 83% (median duration, 25 minutes; interquartile range, 5-65). During a median follow-up of 3.9 years, diabetes developed in 284 patients (25%). The cumulative incidence of diabetes was proportional to increases in the duration and depth of IOH (P < .001). For the median duration in IOH compared with a reference time of 0 minutes, the hazard ratio was 1.48 (95% CI, 1.14-1.92). The effect of IOH was pronounced with distal pancreatectomy. Furthermore, the duration of IOH was inversely correlated with 1-year HOMA β-cell function (P < .002), but not with HOMA insulin resistance. These results support the hypothesis that IOH during pancreatectomy may elevate risk of diabetes by inducing β-cell insufficiency.

Management Modalities of Pancreatic Cancer and Surgical Outcomes of Braun's Anastomosis Addition in Whipple's Procedure: A Single-center Prospective Study

Background: Pancreatic cancer is an aggressive malignancy with high mortality rate. Many morbidities associated with Whipple's procedure that endanger patients’ life which need updated surgical techniques to lower these morbidities. The aim of this study is to determine management modalities of pancreatic cancer and surgical outcomes of adding Braun's jejunojejunostomy to Whipple's procedure for reduction of postoperative risks in Sudanese patients to reach excellent surgical practice. Subjects and Methods: This is a prospective-cohort study conducted during the period between January 2022 and July 2023 at Ibn Sina specialized hospital, Khartoum, Sudan, on sixty-three patients diagnosed with resectable pancreatic cancer. Addition of Braun’s jejunojejunostomy to elective open Whipple’s surgery was performed. Results: Seventy-three percent of patients diagnosed with pancreatic cancer were males with the ratio (3:1). Patients’ distribution according to age ranged between 46 and 60 years representing (41.3%). The significant reported comorbidities that associated with PC were diabetes mellitus (30.2%) and businessmen (39.7%). Most of patients were lived in rural areas (57.1%). Abdominopelvic CT-scan revealed stage (II) of pancreatic cancer in (68.2%) of patients. The predominant morbidity after addition of Braun's jejunojejunostomy was wound infections noticed in (17.5%) of patients. Moreover, other complications were categorized as follows: pulmonary infections in (6.35 %) of cases, postoperative diabetes mellitus in (4.76 %) of cases, entero-cutaneous fistula in (4.76 %) of cases, delayed gastric emptying in (3.17%) of cases, biliary leak in (3.17%) of cases, (3.17%) of cases, pancreatic fistula in one case (1.58%), gastric outlet obstruction in one case (1.58%) and postoperative GIT bleeding in one case (1.58%). Postoperative hospital stay of patients were ranged between 8-15 days for (66.7%) of cases. The mortality rate was zero. Conclusions: To reduce the rate of lethal surgical morbidities of Whipple's procedure, we recommend addition of Braun's jejunojejunostomy as useful technique. Moreover, it will potentially help in improving the quality of surgical practice and survival outcomes of patients who diagnosed with pancreatic cancer.