Karan J Yagnik1, Dana Erickson2, Irina Bancos2, John L D Atkinson1, Garret Choby3, Maria Peris-Celda1, Jamie J Van Gompel4,5. 1. Department of Neurological Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA. 2. Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA. 3. Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA. 4. Department of Neurological Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA. vangompel.jamie@mayo.edu. 5. Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA. vangompel.jamie@mayo.edu.
Abstract
PURPOSE: In Prolactinomas, surgery or radiation are reserved for DA failure due to tumor resistance, intolerance to medication-induced side-effects, or patient preference. This systematic review and meta-analysis summarizes the currently available literature regarding the effectiveness of surgery to treat prolactinomas in patients who have failed DA therapy. METHOD: A literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies that reported outcomes of medically resistant and intolerant prolactinoma treated surgically. RESULTS: 10 articles (Total N = 816, Surgery N = 657) met the inclusion criteria. 38% of patients who underwent surgery following DA failure achieved remission without need for further treatment (p < 0.001, I2 = 67.09%) with a median follow-up of 49.2 +/- 40 months. 62% achieved remission with multimodal treatment (p < 0.001, I2 = 93.28%) with a median follow-up of 53 +/- 39.8 months. 16% of cases demonstrated recurrence after early remission (p = 0.02, I2 = 62.91%) with recurrence occurring on average at 27 +/- 9 months. Overall, 46% of patients required reinstitution of postoperative DA therapy at last follow up (p < 0.001, I2 = 82.57%). Subgroup analysis of macroprolactinoma and microprolactinoma has demonstrated that there is no statistical significance in achieving long-term remission with surgery stand-alone in macroprolactinoma group (p = 0.49) although 43% of patients were able to achieve remission with multimodal therapy at last follow-up in the same group (p < 0.001, I2 = 86.34%). CONCLUSIONS: This systematic review and meta-analysis revealed 38% of operated patients achieved remission, while 62% achieved remission when additional modes of therapy were implemented. Therefore, although surgery has not been initial therapeutic choice for prolactinoma, it plays a significant role in medically failed prolactinoma care.
PURPOSE: In Prolactinomas, surgery or radiation are reserved for DA failure due to tumor resistance, intolerance to medication-induced side-effects, or patient preference. This systematic review and meta-analysis summarizes the currently available literature regarding the effectiveness of surgery to treat prolactinomas in patients who have failed DA therapy. METHOD: A literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies that reported outcomes of medically resistant and intolerant prolactinoma treated surgically. RESULTS: 10 articles (Total N = 816, Surgery N = 657) met the inclusion criteria. 38% of patients who underwent surgery following DA failure achieved remission without need for further treatment (p < 0.001, I2 = 67.09%) with a median follow-up of 49.2 +/- 40 months. 62% achieved remission with multimodal treatment (p < 0.001, I2 = 93.28%) with a median follow-up of 53 +/- 39.8 months. 16% of cases demonstrated recurrence after early remission (p = 0.02, I2 = 62.91%) with recurrence occurring on average at 27 +/- 9 months. Overall, 46% of patients required reinstitution of postoperative DA therapy at last follow up (p < 0.001, I2 = 82.57%). Subgroup analysis of macroprolactinoma and microprolactinoma has demonstrated that there is no statistical significance in achieving long-term remission with surgery stand-alone in macroprolactinoma group (p = 0.49) although 43% of patients were able to achieve remission with multimodal therapy at last follow-up in the same group (p < 0.001, I2 = 86.34%). CONCLUSIONS: This systematic review and meta-analysis revealed 38% of operated patients achieved remission, while 62% achieved remission when additional modes of therapy were implemented. Therefore, although surgery has not been initial therapeutic choice for prolactinoma, it plays a significant role in medically failed prolactinoma care.
Authors: O Serri; H Beauregard; J Lesage; L Pedneault; R Comtois; N Jilwan; M Somma; L Vachon; J Brownell Journal: J Clin Endocrinol Metab Date: 1990-09 Impact factor: 5.958
Authors: Shlomo Melmed; Felipe F Casanueva; Andrew R Hoffman; David L Kleinberg; Victor M Montori; Janet A Schlechte; John A H Wass Journal: J Clin Endocrinol Metab Date: 2011-02 Impact factor: 5.958
Authors: W A Bashari; M van der Meulen; J MacFarlane; D Gillett; R Senanayake; L Serban; A S Powlson; A M Brooke; D J Scoffings; J Jones; D G O'Donovan; J Tysome; T Santarius; N Donnelly; I Boros; F Aigbirhio; S Jefferies; H K Cheow; I A Mendichovszky; A G Kolias; R Mannion; O Koulouri; M Gurnell Journal: Pituitary Date: 2022-05-24 Impact factor: 3.599