Reappraisal of microscopic microsurgical transsphenoidal surgery for GH-secreting pituitary macroadenoma in patients with acromegaly: Historical data from Vietnam (2010–2013)

Abstract

Objective: In Vietnam, microscopic transsphenoidal surgery has been implemented to treat acromegaly patients since 2000. However, no specific outcome studies have been conducted. We assess outcomes of this technique and factors associated with remission. Methods: This prospective observational study was conducted in 43 patients with acromegaly resulting from Growth Hormone (GH)-secreting pituitary macroadenoma. The primary outcome of interest was remission status, as defined by random GH levels below 2.5 ng/mL and Insulin-like Growth Factor-1 (IGF-1) within the normal range three months post-operation. Results: The proportion of patients with remission three months after surgery was 69.8% with a 95% confidence interval (CI) = 53.9–82.8%. The proportions of residual tumors three months after surgery in the remission and non-remission groups were 10.0% (3/27) and 23.1% (3/10), respectively, but there was no significant difference between these proportions (Fisher's exact test, p = 0.35). In a multivariate logistic regression analysis adjusted for sex and age, remission was associated with the absence of cavernous sinus invasion, with an odds ratio (OR) = 5.2 (95% CI = 1.1–26.5). In addition, remission was also associated with a post-operative GH level < 2.5 ng/mL (OR = 7.4, 95% CI = 1.1–48.0). Conclusion: We report that the proportion of patients with disease remission three months after surgery was high, indicating that microscopic transsphenoidal surgery was efficacious. More studies should be conducted to assess outcomes of various acromegaly treatment methods in the current context of Vietnam.

Keywords

• Microscopic transsphenoidal surgery
• Acromegaly
• Pituitary adenoma
• Macroadenoma
• Vietnam