• Yasuo Sasagawa, Yasuhiko Hayashi, Osamu Tachibana, Atsushi Nakagawa, Masahiro Oishi, Toshinari Takamura, Hideaki Iizuka, and Mitsutoshi Nakada.
• Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan. Electronic address: y-sasa@med.kanazawa-u.ac.jp.
• World Neurosurg. 2018 Oct 1; 118: e229-e234.

BackgroundElderly patients with acromegaly who have comorbidities may increasingly encounter perioperative complications; however, little data are available on the risks and outcomes of surgical treatment in these patients. We aimed to analyze and compare the results of transnasal transsphenoidal surgery (TTS) in elderly and younger patients.MethodsEighty-seven consecutive patients with acromegaly who underwent TTS were included. We divided the patients into elderly (≥65 years) and younger (<65 years) groups and compared clinical characteristics, anesthesia risk, and surgical outcomes in these 2 groups.ResultsThe 87 patients included 24 (27.6%) in the elderly group and 63 (73.4%) in the younger group. Preoperative endocrinologic and radiologic assessments showed no significant differences between the 2 groups. Although a grade 3 American Society of Anesthesiologists Physical Status classification was more common in the elderly group (75% vs. 3%; P = 0.00001) owing to the severity of associated diseases, no significant between-group difference in perioperative complications was seen (17% vs. 6%; P = 0.142). Sixteen elderly patients and 45 younger patients achieved endocrinologic remission following surgery (67% vs. 71%; P = 0.426). The incidence rate of postoperative new pituitary deficit was similar in the elderly and younger groups (4% vs. 3%; P = 0.625). Approximately one-third of the elderly patients with diagnosed hypertension or diabetes mellitus tapered their medication after successful tumor removal.ConclusionsTTS can be considered a safe treatment for both younger and elderly patients with acromegaly. Successful tumor removal provided a significant improvement in comorbidities even in elderly patients with acromegaly.Copyright © 2018 Elsevier Inc. All rights reserved.

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