The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’

TLDR

Biochemical cure is defined by normal basal GH, suppressed GH < 1 ng/ml after oral glucose, and normal IGF‑I, yet in patients with extended, invasive tumours and high secretory activity surgery alone rarely achieves cure, necessitating additional therapy. The study aims to illustrate the current role of transsphenoidal surgery as primary therapy in GH‑secreting adenomas and compare disease control results with older cure criteria. They reviewed 688 acromegalic patients treated over 19 years, assessing primary transsphenoidal surgery outcomes using current biochemical cure criteria. In 506 patients undergoing primary transsphenoidal surgery, 57.3 % achieved biochemical cure, with complication rates below 2 %, mortality of 0.1 %, a 0.4 % recurrence over 10.7 years, and cure rates inversely related to initial GH, tumour size, and invasion, confirming surgery as the preferred first‑line treatment despite lower success in extended tumours or after repeat/transcranial procedures.

Abstract

The aim of this study was to illustrate the present role of transsphenoidal surgery as primary therapy in GH-secreting adenomas, and to compare the results concerning control of disease with previous series using older criteria of cure.We report on a consecutive series of 688 acromegalic patients treated over a time period of 19 years. Biochemical cure was defined as normalisation of basal GH level, suppression of GH levels to below 1 ng/ml during an oral glucose load and normalisation of IGF-I levels. Of the 506 patients undergoing primary transsphenoidal surgery, a total of 57.3% postoperatively fulfilled the criteria used.The rate of biochemical 'cure' correlated with the magnitude of the initial GH levels, the tumour size and invasion. The overall complication rate was below 2%. Mortality in this series was 0.1% (1 of 688). During a follow-up period of 10.7 years only two recurrences (0.4%) occurred. However, in the patients treated by transcranial surgery and by repeat surgery the cure rate was found to be relatively low (5.2 and 21.3% respectively).These data suggest that surgery remains with very few exceptions the primary treatment of acromegaly for (i) a high cure rate, (ii) low morbidity, (iii) low recurrence rate and (iv) immediate decline of GH. Based on current criteria of cure, recurrences are uncommon. However, cure by surgery alone is improbable in patients harbouring extended, invasive tumours with high secretory activity, in whom further adjuvant treatment is mandatory.