Place of preoperative treatment of acromegaly with somatostatin analog on surgical outcome: a systematic review and meta-analysis

PLoS One. 2013 Apr 25;8(4):e61523. doi: 10.1371/journal.pone.0061523. Print 2013.

Abstract

Context: Transsphenoidal neurosurgery is the accepted first-line treatment of acromegaly in the majority of patients. Previous studies addressing preoperative somatostatin analog (SSA) treatment and subsequent surgical cure rates are conflicting, reporting either benefits or no significant differences.

Objective: The aim of this study, based on a meta-analysis of all published reports, was to investigate whether treatment with SSA before surgery improves the surgical outcome of acromegaly.

Data sources: All studies of preoperative treatment of acromegaly with SSA were systematically reviewed up to December 2011. We searched the Medline, Embase, Cochrane and Google Scholar electronic databases.

Study selection: The primary endpoint was the biochemical postoperative cure rate. We identified 286 studies, out of which 10 studies (3.49%) fulfilling the eligibility criteria were selected for analysis; five retrospective studies with a control group, two prospective non-randomized trials, and three prospective controlled trials. The meta-analysis was conducted using the random-effects model.

Data extraction: Data were extracted from published reports by two independent observers.

Data synthesis: A borderline effect was detected in the analysis of all of the trials with control groups, with a pooled odds ratio (OR) for biochemical cure with SSA treatment of 1.62 (95% CI, 0.93-2.82). In the analysis of the three prospective controlled trials, a statistically significant effect was identified OR: 3.62 (95% CI, 1.88-6.96).

Conclusions: Preoperative treatment with SSA og GH-secreting pituitary adenomas shows a significant improvement on surgical results. This meta-analysis suggests that in centers without optimal results all patients with a GH-secreting pituitary macroadenoma should be treated with a long-acting SSA prior to surgical treatment.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Acromegaly / drug therapy*
  • Acromegaly / surgery*
  • Humans
  • Length of Stay
  • Preoperative Care / methods*
  • Randomized Controlled Trials as Topic
  • Somatostatin / analogs & derivatives*
  • Somatostatin / therapeutic use*
  • Treatment Outcome

Substances

  • Somatostatin

Grant support

This work was supported in part by: FIS del Instituto de Salud Carlos III PI070413, PI10/00088 and Xunta de Galicia PS07/12, INCITE08ENA916110ES, INCITE09E1R91634ES, IN845B-2010/187, 10CSA916014PR, Spain. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.