Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas: the Transsphenoidal Extent of Resection (TRANSSPHER) Study
Many surgeons have adopted fully endoscopic over microscopic transsphenoidal surgery for nonfunctioning pituitary tumors, although no high-quality evidence demonstrates superior patient outcomes with endoscopic surgery. The goal of this analysis was to compare these techniques in a prospective multi...
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Published in | Journal of neurosurgery Vol. 132; no. 4; p. 1043 |
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Main Authors | , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
01.04.2020
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Abstract | Many surgeons have adopted fully endoscopic over microscopic transsphenoidal surgery for nonfunctioning pituitary tumors, although no high-quality evidence demonstrates superior patient outcomes with endoscopic surgery. The goal of this analysis was to compare these techniques in a prospective multicenter controlled study.
Extent of tumor resection was compared after endoscopic or microscopic transsphenoidal surgery in adults with nonfunctioning adenomas. The primary end point was gross-total tumor resection determined by postoperative MRI. Secondary end points included volumetric extent of tumor resection, pituitary hormone outcomes, and standard quality measures.
Seven pituitary centers and 15 surgeons participated in the study. Of the 530 patients screened, 260 were enrolled (82 who underwent microscopic procedures, 177 who underwent endoscopic procedures, and 1 who cancelled surgery) between February 2015 and June 2017. Surgeons who used the microscopic technique were more experienced than the surgeons who used the endoscopic technique in terms of years in practice and number of transsphenoidal surgeries performed (p < 0.001). Gross-total resection was achieved in 80.0% (60/75) of microscopic surgery patients and 83.7% (139/166) of endoscopic surgery patients (p = 0.47, OR 0.8, 95% CI 0.4-1.6). Volumetric extent of resection, length of stay, surgery-related deaths, and unplanned readmission rates were similar between groups (p > 0.2). New hormone deficiency was present at 6 months in 28.4% (19/67) of the microscopic surgery patients and 9.7% (14/145) of the endoscopic surgery patients (p < 0.001, OR 3.7, 95% CI 1.7-7.7). Microscopic surgery cases were significantly shorter in duration than endoscopic surgery cases (p < 0.001).
Experienced surgeons who performed microscopic surgery and less experienced surgeons who performed endoscopic surgery achieved similar extents of tumor resection and quality outcomes in patients with nonfunctioning pituitary adenomas. The endoscopic technique may be associated with lower rates of postoperative pituitary gland dysfunction. This study generally supports the transition to endoscopic pituitary surgery when the procedure is performed by proficient surgeons, although both techniques yield overall acceptable surgical outcomes.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: prospective cohort trial; evidence: class III.Clinical trial registration no.: NCT02357498 (clinicaltrials.gov). |
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AbstractList | Many surgeons have adopted fully endoscopic over microscopic transsphenoidal surgery for nonfunctioning pituitary tumors, although no high-quality evidence demonstrates superior patient outcomes with endoscopic surgery. The goal of this analysis was to compare these techniques in a prospective multicenter controlled study.
Extent of tumor resection was compared after endoscopic or microscopic transsphenoidal surgery in adults with nonfunctioning adenomas. The primary end point was gross-total tumor resection determined by postoperative MRI. Secondary end points included volumetric extent of tumor resection, pituitary hormone outcomes, and standard quality measures.
Seven pituitary centers and 15 surgeons participated in the study. Of the 530 patients screened, 260 were enrolled (82 who underwent microscopic procedures, 177 who underwent endoscopic procedures, and 1 who cancelled surgery) between February 2015 and June 2017. Surgeons who used the microscopic technique were more experienced than the surgeons who used the endoscopic technique in terms of years in practice and number of transsphenoidal surgeries performed (p < 0.001). Gross-total resection was achieved in 80.0% (60/75) of microscopic surgery patients and 83.7% (139/166) of endoscopic surgery patients (p = 0.47, OR 0.8, 95% CI 0.4-1.6). Volumetric extent of resection, length of stay, surgery-related deaths, and unplanned readmission rates were similar between groups (p > 0.2). New hormone deficiency was present at 6 months in 28.4% (19/67) of the microscopic surgery patients and 9.7% (14/145) of the endoscopic surgery patients (p < 0.001, OR 3.7, 95% CI 1.7-7.7). Microscopic surgery cases were significantly shorter in duration than endoscopic surgery cases (p < 0.001).
Experienced surgeons who performed microscopic surgery and less experienced surgeons who performed endoscopic surgery achieved similar extents of tumor resection and quality outcomes in patients with nonfunctioning pituitary adenomas. The endoscopic technique may be associated with lower rates of postoperative pituitary gland dysfunction. This study generally supports the transition to endoscopic pituitary surgery when the procedure is performed by proficient surgeons, although both techniques yield overall acceptable surgical outcomes.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: prospective cohort trial; evidence: class III.Clinical trial registration no.: NCT02357498 (clinicaltrials.gov). |
Author | Barkhoudarian, Garni Little, Andrew S Mayberg, Marc R Chicoine, Michael R Kelly, Daniel F Fernandez-Miranda, Juan C Chandler, James P Gardner, Paul A Liebelt, Brandon D Sfondouris, John Prevedello, Daniel M White, William L |
Author_xml | – sequence: 1 givenname: Andrew S surname: Little fullname: Little, Andrew S organization: 1Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona – sequence: 2 givenname: Daniel F surname: Kelly fullname: Kelly, Daniel F organization: 2Pacific Brain Tumor Center and Pituitary Disorders Program, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California – sequence: 3 givenname: William L surname: White fullname: White, William L organization: 1Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona – sequence: 4 givenname: Paul A surname: Gardner fullname: Gardner, Paul A organization: 3University of Pittsburgh, Pittsburgh, Pennsylvania – sequence: 5 givenname: Juan C surname: Fernandez-Miranda fullname: Fernandez-Miranda, Juan C organization: 3University of Pittsburgh, Pittsburgh, Pennsylvania – sequence: 6 givenname: Michael R surname: Chicoine fullname: Chicoine, Michael R organization: 4Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri – sequence: 7 givenname: Garni surname: Barkhoudarian fullname: Barkhoudarian, Garni organization: 2Pacific Brain Tumor Center and Pituitary Disorders Program, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California – sequence: 8 givenname: James P surname: Chandler fullname: Chandler, James P organization: 5Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois – sequence: 9 givenname: Daniel M surname: Prevedello fullname: Prevedello, Daniel M organization: 6Department of Neurological Surgery, The Ohio State University, Columbus, Ohio; and – sequence: 10 givenname: Brandon D surname: Liebelt fullname: Liebelt, Brandon D organization: 1Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona – sequence: 11 givenname: John surname: Sfondouris fullname: Sfondouris, John organization: 1Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona – sequence: 12 givenname: Marc R surname: Mayberg fullname: Mayberg, Marc R organization: 7Department of Neurological Surgery, University of Washington, Seattle, Washington |
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Title | Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas: the Transsphenoidal Extent of Resection (TRANSSPHER) Study |
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