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Evaluation of Surgical Resection Goal and Its Relationship to Extent of Resection and Patient Outcomes in a Multicenter Prospective Study of Patients With Surgically Treated, Nonfunctioning Pituitary Adenomas: A Case Series.
- Source :
-
Operative neurosurgery (Hagerstown, Md.) [Oper Neurosurg (Hagerstown)] 2020 Jan 01; Vol. 18 (1), pp. 26-33. - Publication Year :
- 2020
-
Abstract
- Background: The influence of the surgeon's preoperative goal regarding the extent of tumor resection on patient outcomes has not been carefully studied among patients with nonfunctioning pituitary adenomas.<br />Objective: To analyze the relationship between surgical tumor removal goal and patient outcomes in a prospective multicenter study.<br />Methods: Centrally adjudicated extent of tumor resection (gross total resection [GTR] and subtotal resection [STR]) data were analyzed using standard univariate and multivariable analyses.<br />Results: GTR was accomplished in 148 of 171 (86.5%) patients with planned GTR and 32 of 50 (64.0%) patients with planned STR (P = .001). Sensitivity, specificity, positive predictive value, and negative predictive value of GTR goal were 82.2, 43.9, 86.5, and 36.0%, respectively. Knosp grade 0-2, first surgery, and being an experienced surgeon were associated with surgeons choosing GTR as the goal (P < .01). There was no association between surgical goal and presence of pituitary deficiency at 6 mo (P = .31). Tumor Knosp grade (P = .004) and size (P = .001) were stronger predictors of GTR than was surgical goal (P = .014). The most common site of residual tumor was the cavernous sinus (29 of 41 patients; 70.1%).<br />Conclusion: This is the first pituitary surgery study to examine surgical goal regarding extent of tumor resection and associated patient outcomes. Surgical goal is a poor predictor of actual tumor resection. A more aggressive surgical goal does not correlate with pituitary gland dysfunction. A better understanding of the ability of surgeons to meet their expectations and of the factors associated with surgical result should improve prognostication and preoperative counseling.<br /> (Copyright © 2019 by the Congress of Neurological Surgeons.)
Details
- Language :
- English
- ISSN :
- 2332-4260
- Volume :
- 18
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Operative neurosurgery (Hagerstown, Md.)
- Publication Type :
- Academic Journal
- Accession number :
- 31079156
- Full Text :
- https://doi.org/10.1093/ons/opz085