TY - JOUR
T1 - Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas
T2 - The Transsphenoidal Extent of Resection (TRANSSPHER) Study
AU - TRANSSPHER Study Group
AU - Little, Andrew S.
AU - Kelly, Daniel F.
AU - White, William L.
AU - Gardner, Paul A.
AU - Fernandez-Miranda, Juan C.
AU - Chicoine, Michael R.
AU - Barkhoudarian, Garni
AU - Chandler, James P.
AU - Prevedello, Daniel M.
AU - Liebelt, Brandon D.
AU - Sfondouris, John
AU - Mayberg, Marc R.
N1 - Publisher Copyright:
© AANS 2020.
PY - 2020
Y1 - 2020
N2 - Objective: 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. Methods: 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. Results: 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). Conclusions: 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 readmisperformed 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.
AB - Objective: 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. Methods: 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. Results: 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). Conclusions: 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 readmisperformed 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.
KW - Endoscopic surger
KW - Extent of resection
KW - Microscopic surgery
KW - Nonfunctioning adenoma
KW - Pituitary surgery
KW - Transsphenoidal surgery
UR - http://www.scopus.com/inward/record.url?scp=85082811044&partnerID=8YFLogxK
U2 - 10.3171/2018.11.JNS181238
DO - 10.3171/2018.11.JNS181238
M3 - Article
C2 - 30901746
AN - SCOPUS:85082811044
SN - 0022-3085
VL - 132
SP - 1043
EP - 1053
JO - Journal of Neurosurgery
JF - Journal of Neurosurgery
IS - 4
ER -