TY - JOUR
T1 - 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
T2 - A case series
AU - TRANSSPHER Study Group
AU - Little, Andrew S.
AU - Chicoine, Michael R.
AU - Kelly, Daniel F.
AU - Sarris, Christina E.
AU - Mooney, Michael A.
AU - White, William L.
AU - Gardner, Paul A.
AU - Fernandez-Miranda, Juan C.
AU - Barkhoudarian, Garni
AU - Chandler, James P.
AU - Prevedello, Daniel M.
AU - Liebelt, Brandon D.
AU - Sfondouris, John
AU - Mayberg, Marc R.
N1 - Funding Information:
This study was supported by the Barrow Neurological Foundation, Phoenix, Arizona, and the Center for Cranial Base Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Dr Little is a stockholder in Kogent Surgical LLC and has stock options in SPIWay LLC. Dr Kelly receives royalties from Mizuho America Inc. Dr Chicoine has received unrestricted grant funding from IMRIS Inc. Dr Barkhoudarian has received consulting fees from Vascular Technology Inc. Dr Gardner is a stockholder in SPIWay LLC. Dr Prevedello is a consultant for Stryker Corp, Medtronic, and Codman Neuro, and he receives royalties from KLS Martin LP.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - 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. OBJECTIVE: To analyze the relationship between surgical tumor removal goal and patient outcomes in a prospective multicenter study. METHODS: Centrally adjudicated extent of tumor resection (gross total resection [GTR] and subtotal resection [STR]) data were analyzed using standard univariate and multivariable analyses. 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%). 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.
AB - 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. OBJECTIVE: To analyze the relationship between surgical tumor removal goal and patient outcomes in a prospective multicenter study. METHODS: Centrally adjudicated extent of tumor resection (gross total resection [GTR] and subtotal resection [STR]) data were analyzed using standard univariate and multivariable analyses. 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%). 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.
KW - Endoscopic surgery
KW - Extent of resection
KW - Microscopic surgery
KW - Nonfunctioning adenoma
KW - Transsphenoidal surgery
UR - http://www.scopus.com/inward/record.url?scp=85076584362&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85076584362&partnerID=8YFLogxK
U2 - 10.1093/ons/opz085
DO - 10.1093/ons/opz085
M3 - Article
C2 - 31079156
AN - SCOPUS:85076584362
VL - 18
SP - 26
EP - 33
JO - Operative Neurosurgery
JF - Operative Neurosurgery
SN - 2332-4252
IS - 1
ER -