[en] Between November 1994 and June 2001, 194 patients with Cushing's disease underwent transsphenoidal surgery: 167 patients had adenomectomy, 14 had ante hypophysectomy, 5 had subtotal hypophysectomy, 4 had hemihypophysectomy 4 had central hypophysectomy. Complications occurred in 18 patients (9.3%), including 4 deaths (three were apparently not related to surgery). Remission of disease was achieved in 162 of 190 (85.3%) patients analyzed. Surgical failures were associated with lack of pituitary adenoma, size of the tumor and invasiveness. Among patients with confirmed adenomas, the rate of remission was significantly higher (p<0.01) in patients with microadenomas (92.6%) than in patients with macroadenomas (66.7%). Reoperation in 6 failures was followed by remission in 4 cases. The overall remission rate was 87.4%. In the 162 patients with immediate success, duration of follow-up was 10.0 +/- 5.9 years (m +/- DS; median=10.0). Recurrence of the disease occurred in 24 (14.8%) of 162 patients at a mean 4.8 years (range: 0.8-12.0 years). Our longest sustained remission is 25.6 years. Actuarial analysis indicates that the probability of a patient remaining well 12 years after surgery is 80.0%. It is 86.2% in microadenomas versus 52.5% in macroadenomas and 94.5% in the patients with postoperative hypocortisolism versus 59.2% in the others. [fr] De novembre 1974 à juin 2001, 194 patients atteints de maladie de Cushing ont été opérés par voie transsphénoïdale selon les procédures suivantes : adénomectomie (167 cas), antéhypophysectomie (14 cas), hypophysectomie subtotale (5 cas), hémihypophysectomie (4 cas) et hypophysectomie centrale (4 cas). Des complications sont survenues chez 18 patients (9,3 %), dont quatre sont décédés (trois sans relation directe avec le geste chirurgical). Une rémission immédiate de la maladie fut obtenue chez 162 des 190 patients suivis (85,3 %). Les causes d'échecs furent en rapport avec l'absence d'identification de l'adénome hypophysaire, la taille et le caractère envahissant de la tumeur. Lorsque l'adénome a été identifié, le pourcentage de rémission fut significativement plus élevé (p < 0,01 %) dans les microadénomes (92,6 %) que dans les macroadénomes (66,7 %). Quatre rémissions ont été obtenues après ré-opération dans 6 cas, ce qui porte à 87,4 % le taux global de rémission. Les 162 patients en rémission immédiate ont été suivis pendant 10,0 ± 5,9 ans (m ± ET; médiane = 10,0). Une récidive de la maladie est survenue dans 24 cas (14,8 %) dans un délai moyen de 4,8 ans (extrêmes: 0,8-12,0). La plus longue durée de rémission est de 25,6 ans. L'étude actuarielle montre que la probabilité pour un patient de rester indemne de maladie 12 ans après la chirurgie est de 80,0 %; elle est de 86,2 % dans les microadénomes et 52,5 % dans les macroadénomes, de 94,5 % chez les patients en hypocortisolisme postopératoire et de 29,2 % chez les patients en eucortisolisme.
Disciplines :
Surgery Neurology Endocrinology, metabolism & nutrition
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