Presurgical treatment with somatostatin analogs in patients with acromegaly: effects on the remission and complication rates

Object The question of whether preoperative therapy with somatostatin analogs can improve surgical outcome in acromegaly has not been definitively answered. In this paper, the authors report the effects of preoperative treatment with somatostatin analogs in a large sample of patients with acromegaly. Methods Between 1990 and 2003, 399 consecutive patients with acromegaly underwent surgery at the Istituto Scientifico San Raffaele. Thirty-three patients who had previously undergone surgery or radiation treatment, 48 patients treated with somatostatin analogs for fewer than 3 months, and patients who had stopped therapy for too long a time before surgery were excluded from the study. One hundred forty-three patients who had received somatostatin analogs prior to surgery (Group 1) were randomly matched to 143 patients who had never been treated with somatostatin analogs (Group 2). Matching criteria were tumor size and invasiveness into the cavernous sinus. Before surgery, Group 1 patients showed reduction of growth hormone levels to less than 50% of baseline in 64% of cases, but insulin-like growth factor–I was normalized in only 19.5%. Surgical remission occurred in 81 Group 1 patients (56.6%) and in 91 Group 2 patients (63.6%; p = 0.28). No significant difference in the remission rate was observed when cases were analyzed according to tumor size or invasiveness. Logistic regression analysis confirmed that pretreatment with somatostatin analogs was not associated with surgical outcome. Surgical morbidity was mild and similar in Group 1 and Group 2 patients (7 and 5.6%, respectively; p = 0.81). Surgical remission and complication rates in patients with acromegaly who received treatment with somatostatin analogs prior to surgery were not significantly different from those of matched patients who did not receive these agents. Conclusions At present, the routine use of presurgical therapy with somatostatin analogs for patients with acromegaly cannot be recommended.

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Study analyzes postsurgical complication rates, factors

Hospitalist News ◽

10.1016/s1875-9122(13)70011-7 ◽

2013 ◽

Vol 6 (1) ◽

pp. 13-14

Author(s):

ELIZABETH MECHCATIE

Keyword(s):

Complication Rates ◽

Postsurgical Complication

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Banding Complication Rates in Teens Mirror Those in Adults

Family Practice News ◽

10.1016/s0300-7073(07)70890-3 ◽

2007 ◽

Vol 37 (14) ◽

pp. 38 ◽

Cited By ~ 1

Author(s):

MITCHEL L. ZOLER

Keyword(s):

Complication Rates

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Complication rates in long-term survivors after implantation of magnetically levitated left ventricular assist devices

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0034-1367417 ◽

2014 ◽

Vol 62 (S 01) ◽

Author(s):

R. Tandler ◽

M. Kondruweit ◽

C. Heim ◽

M. Weyand

Keyword(s):

Left Ventricular ◽

Ventricular Assist Devices ◽

Complication Rates ◽

Left Ventricular Assist Devices ◽

Ventricular Assist ◽

Assist Devices ◽

Left Ventricular Assist ◽

Magnetically Levitated ◽

Long Term Survivors

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Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

The Journal of Knee Surgery ◽

10.1055/s-0040-1712100 ◽

2020 ◽

Author(s):

Antonio Klasan ◽

Sven Edward Putnis ◽

Wai Weng Yeo ◽

Darli Myat ◽

Brett Andrew Fritsch ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Patient Selection ◽

Knee Arthroplasty ◽

Major Complication ◽

The Elderly ◽

Complication Rates ◽

Bilateral Total Knee Arthroplasty ◽

Proper Patient Selection ◽

Patient Reported ◽

Total Knee

AbstractDespite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.

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