The effects of pre-operative somatostatin analogue therapy on treatment cost and remission in acromegaly

Purpose

To investigate the effects of preoperative somatostatin analogue (SSA) treatment on the annual cost of all acromegaly treatment modalities and on remission rates.

Methods

The medical records of 135 patients with acromegaly who were followed at endocrinology clinic of Cerrahpasa Medical Faculty for at least 2 years after surgery between 2009 and 2016 were reviewed.

Results

The mean follow-up time was 50.9?±?25.7 months. Early remission was defined according to 3rd month values in patients who didn’t achieve remission, and 6th month values in patients who achieved remission at the 3rd month after surgery. The early and late remission rates of the entire study population were 40% and 80.7%, respectively. The early remission of the preoperative SSA-treated group (61.5%) was significantly higher than SSA-untreated group (31.2%) (p?=?0.002). The early remission of the preoperative SSA-treated patients with macroadenomas (52.2%) was also significantly higher than the SSA-untreated group (23.5%) (p?=?0.02). In the subgroup analysis; this difference was much more pronounced in invasive macroadenomas (p?=?0.002). There were no differences between the groups in terms of late remission.The median annual cost of all acromegaly treatment modalities in study population was €3788.4; the cost for macroadenomas was significantly higher than for microadenomas (€4125.0 vs. €3226.5, respectively; p?=?0.03). Preoperative SSA use in both microadenomas and macroadenomas didn’t alter the cost of treatment. The increase in the duration of preoperative medical treatment had no effect on early or late remissions (p?=?0.09; p?=?0.8).

Conclusions

Preoperative medical treatment had no effect on the costs of acromegaly treatment. There was a benefical effect of pre-operative SSA use on early remission in patients with macroadenomas; however, this effect didn’t persist long term.

     

No need for systemic heparinization during laparoscopic donor nephrectomy with short warm ischemia time

Purpose  

Systemic heparin administration during laparoscopic donor nephrectomy (LDN) may prevent microvascular thrombus formation following warm ischemia. We herein present our experience with and without systemic heparinization during LDN.