ausblenden:
Schlagwörter:
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Zusammenfassung:
Objective: A number of factors can influence the reported outcomes of
transsphenoidal surgery (TSS) for Cushing's disease including different
remission and recurrence criteria, for which there is no consensus.
Therefore, a comparative analysis of the best treatment options and
patient management strategies is difficult. In this review, we
investigated the clinical outcomes of initial TSS in patients with
Cushing's disease based on definitions of and assessments for remission
and recurrence.
Methods: We systematically searched PubMed and identified 44 studies
with clear definitions of remission and recurrence. When data were
available, additional analyses by time of remission, tumor size,
duration of follow-up, surgical experience, year of study publication
and adverse events related to surgery were performed.
Results: Data from a total of 6400 patients who received microscopic TSS
were extracted and analyzed. A variety of definitions of remission and
recurrence of Cushing's disease after initial microscopic TSS was used,
giving broad ranges of remission (42.0-96.6%; median, 77.9%) and
recurrence (0-47.4%; median, 11.5%). Better remission and recurrence
outcomes were achieved for microadenomas vs macroadenomas; however, no
correlations were found with other parameters, other than improved
safety with longer surgical experience.
Conclusions: The variety of methodologies used in clinical evaluation of
TSS for Cushing's disease strongly support the call for standardization
and optimization of studies to inform clinical practice and maximize
patient outcomes. Clinically significant rates of failure of initial TSS
highlight the need for effective second-line treatments.
