[en] 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 four prospective controlled trials, a statistically significant effect was identified OR: 2.58 (95% CI, 1.14-5.80) Conclusions: Preoperative treatment with SSA of GH-secreting pituitary adenomas shows a significant improvement on surgical results. This meta-analysis strongly 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.

[gl] Contexto: A cirurxía transesfenoidal é o tratamento de primeira liña da acromegalia aceptado na maioría dos pacientes. Os resultados de estudos previos referentes ao tratamento preoperatorio con análogos de somatostatina e as taxas de curación quirúrgica son contradictorios, atopando beneficio nalgúns e ningunha diferenza noutros. Obxectivo: O obxectivo deste traballo, baseado nun meta-análise de todos os estudos publicados, é investigar si o tratamento precirúrxico con análogos de somatostatina mellora o resultado cirúrxico da acromegalia. Fontes de datos: Realizouse unha revisión sistemática de todos os estudos de tratamento precirúrxico de acromegalia con análogos de somatostatina ata Decembro de 2011. Revisáronse as bases de datos electrónicas Medline, Embase, Cochrane e Google Scholar. O obxectivo primario foi a taxa de curación bioquímica. Identificáronse 286 estudos, seleccionando 10 deles (3.49%) por cumprir os requisitos para a análise; 5 estudos retrospectivos con grupo control, 2 ensaios prospectivos non aleatorizados e 3 ensaios prospectivos controlados. O meta-análise realizouse empregando o modelo de efectos aleatorios. Extracción de datos: A extracción de datos dos estudos realizouse por dous observadores independentes. Síntese de datos: Detectouse un efecto límite na análise global de todos os estudos, cunha odds ratio (OR) para curación bioquímica con tratamento precirúrxico de 1.62 (95% IC, 0.93-2.82). Na análise dos tres ensaios prospectivos controlados, identificouse un efecto estadísticamente significativo cunha OR de 2.58 (95% CI, 1.14-5.80). Conclusión: O tratamento precirúrxico de adenomas hipofisarios productores de GH con análogos de somatostatina produce unha melloría significativa no resultado cirúrxico, analizando ademáis a importancia do tratamento precirúrxico en centros sen resultados cirúrxicos óptimos.