Faucher Pauline, Carette Claire, Jannot Anne-Sophie, Gatta-Cherifi Blandine, Van Straaten Alexis, Piquet Marie-Astrid, Raverot Gerald, Alligier Maud, Batisse Thibault, Ziegler Olivier, Drui Delphine, Bretault Marion, Farigon Nicolas, Slim Karem, Genser Laurent, Poghosyan Tigran, Vychnevskaia Karina, Blanchard Claire, Robert Maud, Gronnier Caroline, Poitou Christine, Czernichow Sébastien
Nutrition Department, French Reference Center for Prader-Willi Syndrome, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, INSERM UMRS NutriOmics, Sorbonne University, 75013, Paris, France.
Service de Nutrition, Hôpital Pitié Salpêtrière, 47-83 Bd de l'hôpital, 75671, Paris Cedex 13, France.
Obes Surg. 2022 Jul;32(7):2321-2331. doi: 10.1007/s11695-022-06079-9. Epub 2022 May 6.
Craniopharyngiomas are tumors located in the hypothalamic region which leads to obesity in about 50% of cases. Long-term efficacy and safety of bariatric surgery are lacking in this peculiar population. The aim of this study is to determine the 5-year weight loss and resolution of type 2 diabetes (T2D) after bariatric surgery in patients operated on craniopharyngioma who had developed hypothalamic obesity.
This is a multicenter french retrospective case-control study. Subjects with craniopharyngioma (n = 23) who underwent sleeve gastrectomy (SG) (n = 9) or Roux-en-Y gastric bypass (RYGB) (n = 14) (median age 35 years [25;43] and BMI 44.2 kg/m [40.7; 51.0]; 8/23 with T2D) were individually matched to 2 subjects with common obesity for age, gender, preoperative body mass index, T2D, and type of surgery.
TWL% after 1 and 5 years was lower in the craniopharyngioma group than in the control group: 23.1 [15.4; 31.1] (23/23) vs 31.4 [23.9; 35.3] at 1 year (p = 0.008) (46/46) and 17.8 [7.1; 21.9] (23/23) vs 26.2 [18.9; 33.9] at 5 years (p = 0.003) (46/46). After RYGB, TWL% was lower in the craniopharyngioma group compared to the control group (p < 0.001) and comparable after SG both at 1 and 5 years. No difference between the two groups was observed in T2D remission rate and in early and late adverse events. No hormonal deficiency-related acute disease was reported.
Bariatric surgery induced a significant weight loss in the craniopharyngioma group at 1 and 5 years, but less than in common obesity. SG may be more effective than RYGB but this remains to be demonstrated in a larger cohort.
颅咽管瘤是位于下丘脑区域的肿瘤，约50%的病例会导致肥胖。对于这一特殊人群，减肥手术的长期疗效和安全性尚缺乏相关研究。本研究的目的是确定接受颅咽管瘤手术并发下丘脑性肥胖的患者在接受减肥手术后5年的体重减轻情况以及2型糖尿病（T2D）的缓解情况。
这是一项多中心的法国回顾性病例对照研究。接受袖状胃切除术（SG）（n = 9）或Roux-en-Y胃旁路术（RYGB）（n = 14）的颅咽管瘤患者（n = 23）（中位年龄35岁[25；43]，体重指数44.2 kg/m²[40.7；51.0]；23例中有8例患有T2D）根据年龄、性别、术前体重指数、T2D和手术类型与2例普通肥胖患者进行个体匹配。
颅咽管瘤组术后1年和5年的体重减轻百分比（TWL%）低于对照组：1年时分别为23.1[15.4；31.1]（23/23）和31.4[23.9；35.3]（46/46）（p = 0.008），5年时分别为17.8[7.1；21.9]（23/23）和26.2[18.9；33.9]（46/46）（p = 0.003）。RYGB术后，颅咽管瘤组的TWL%低于对照组（p < 0.001），SG术后1年和5年时两组相当。两组在T2D缓解率以及早期和晚期不良事件方面未观察到差异。未报告与激素缺乏相关的急性疾病。
减肥手术在颅咽管瘤组术后1年和5年可导致显著体重减轻，但低于普通肥胖患者。SG可能比RYGB更有效，但这仍有待在更大的队列中得到证实。
