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Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma.
J Neurosurg 2016; 124(3):596-604JN

Abstract

OBJECTIVE

The comparative efficacy of microscopic and fully endoscopic transsphenoidal surgery for pituitary adenomas has not been well studied despite the adoption of fully endoscopic surgery by many pituitary centers. The influence of surgeon experience has also not been examined in this setting. The authors therefore compared the extent of tumor resection (EOR) and the endocrine outcomes of 1 very experienced surgeon performing a microscopic transsphenoidal surgery technique with those of a less experienced surgeon using a fully endoscopic transsphenoidal surgery technique for resection of nonfunctioning pituitary adenomas in a concurrent series of patients.

METHODS

Post hoc analysis was conducted of a cohort of adult patients prospectively enrolled in a pituitary adenoma quality-of-life study between October 2011 and June 2014. Patients were followed up for 6 months after surgery. Patients were treated either by a less experienced surgeon (100 independent cases) who practices fully endoscopic surgery exclusively or by a very experienced surgeon (1800 independent cases) who practices microscopic surgery exclusively. Patient demographic characteristics, tumor characteristics, hypopituitarism, complications, and length of hospital stay were analyzed. Tumor volumes and EOR were determined by formal volumetric analysis involving manual segmentation of MR images performed before surgery and within 6 months after surgery. Logistic regression analysis was used to determine predictors of EOR.

RESULTS

Fifty-five patients underwent fully endoscopic transsphenoidal surgery, and 80 patients underwent fully microscopic transsphenoidal surgery. The baseline characteristics of the 2 treatment groups were well matched. EOR was similar between the endoscopic and microscopic groups, respectively, as estimated by gross-total resection rate (78.2% vs 81.3%, p = 0.67), percentage of tumor resected (99.2% vs 98.7%, p = 0.42), and volume of residual tumor (0.12 cm(3) vs 0.20 cm(3), p = 0.41). Multivariate modeling suggested that preoperative tumor volume was the most important predictor of EOR (p = 0.001). No difference was found in the development of anterior gland dysfunction (p > 0.14), but there was a higher incidence of permanent posterior gland dysfunction in the microscopic group (p = 0.04). Combined rates of major complications and unplanned readmissions were lower in the endoscopic group (p = 0.02), but individual complications were not significantly different.

CONCLUSIONS

A less experienced surgeon using a fully endoscopic technique was able to achieve outcomes similar to those of a very experienced surgeon using a microscopic technique in a cohort of patients with nonfunctioning tumors smaller than 60 cm(3). The study raises the provocative notion that certain advantages afforded by the fully endoscopic technique may impact the learning curve in pituitary surgery for nonfunctioning adenomas.

Authors+Show Affiliations

Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; and.Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; and.Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; and.Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; and.Department of Internal Medicine, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; and.Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; and.Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; and.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

26473774

Citation

Zaidi, Hasan A., et al. "Comparison of Outcomes Between a Less Experienced Surgeon Using a Fully Endoscopic Technique and a Very Experienced Surgeon Using a Microscopic Transsphenoidal Technique for Pituitary Adenoma." Journal of Neurosurgery, vol. 124, no. 3, 2016, pp. 596-604.
Zaidi HA, Awad AW, Bohl MA, et al. Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma. J Neurosurg. 2016;124(3):596-604.
Zaidi, H. A., Awad, A. W., Bohl, M. A., Chapple, K., Knecht, L., Jahnke, H., ... Little, A. S. (2016). Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma. Journal of Neurosurgery, 124(3), pp. 596-604. doi:10.3171/2015.4.JNS15102.
Zaidi HA, et al. Comparison of Outcomes Between a Less Experienced Surgeon Using a Fully Endoscopic Technique and a Very Experienced Surgeon Using a Microscopic Transsphenoidal Technique for Pituitary Adenoma. J Neurosurg. 2016;124(3):596-604. PubMed PMID: 26473774.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma. AU - Zaidi,Hasan A, AU - Awad,Al-Wala, AU - Bohl,Michael A, AU - Chapple,Kristina, AU - Knecht,Laura, AU - Jahnke,Heidi, AU - White,William L, AU - Little,Andrew S, Y1 - 2015/10/16/ PY - 2015/10/17/entrez PY - 2015/10/17/pubmed PY - 2016/7/20/medline KW - CSF = cerebrospinal fluid KW - EOR = extent of tumor resection KW - GTR = gross-total resection KW - QOL = quality of life KW - STR = subtotal resection KW - TNTS = transnasal transsphenoidal KW - endoscopic surgery KW - pituitary adenoma KW - pituitary surgery KW - transsphenoidal surgery SP - 596 EP - 604 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 124 IS - 3 N2 - OBJECTIVE: The comparative efficacy of microscopic and fully endoscopic transsphenoidal surgery for pituitary adenomas has not been well studied despite the adoption of fully endoscopic surgery by many pituitary centers. The influence of surgeon experience has also not been examined in this setting. The authors therefore compared the extent of tumor resection (EOR) and the endocrine outcomes of 1 very experienced surgeon performing a microscopic transsphenoidal surgery technique with those of a less experienced surgeon using a fully endoscopic transsphenoidal surgery technique for resection of nonfunctioning pituitary adenomas in a concurrent series of patients. METHODS: Post hoc analysis was conducted of a cohort of adult patients prospectively enrolled in a pituitary adenoma quality-of-life study between October 2011 and June 2014. Patients were followed up for 6 months after surgery. Patients were treated either by a less experienced surgeon (100 independent cases) who practices fully endoscopic surgery exclusively or by a very experienced surgeon (1800 independent cases) who practices microscopic surgery exclusively. Patient demographic characteristics, tumor characteristics, hypopituitarism, complications, and length of hospital stay were analyzed. Tumor volumes and EOR were determined by formal volumetric analysis involving manual segmentation of MR images performed before surgery and within 6 months after surgery. Logistic regression analysis was used to determine predictors of EOR. RESULTS: Fifty-five patients underwent fully endoscopic transsphenoidal surgery, and 80 patients underwent fully microscopic transsphenoidal surgery. The baseline characteristics of the 2 treatment groups were well matched. EOR was similar between the endoscopic and microscopic groups, respectively, as estimated by gross-total resection rate (78.2% vs 81.3%, p = 0.67), percentage of tumor resected (99.2% vs 98.7%, p = 0.42), and volume of residual tumor (0.12 cm(3) vs 0.20 cm(3), p = 0.41). Multivariate modeling suggested that preoperative tumor volume was the most important predictor of EOR (p = 0.001). No difference was found in the development of anterior gland dysfunction (p > 0.14), but there was a higher incidence of permanent posterior gland dysfunction in the microscopic group (p = 0.04). Combined rates of major complications and unplanned readmissions were lower in the endoscopic group (p = 0.02), but individual complications were not significantly different. CONCLUSIONS: A less experienced surgeon using a fully endoscopic technique was able to achieve outcomes similar to those of a very experienced surgeon using a microscopic technique in a cohort of patients with nonfunctioning tumors smaller than 60 cm(3). The study raises the provocative notion that certain advantages afforded by the fully endoscopic technique may impact the learning curve in pituitary surgery for nonfunctioning adenomas. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/26473774/Comparison_of_outcomes_between_a_less_experienced_surgeon_using_a_fully_endoscopic_technique_and_a_very_experienced_surgeon_using_a_microscopic_transsphenoidal_technique_for_pituitary_adenoma_ L2 - https://thejns.org/doi/10.3171/2015.4.JNS15102 DB - PRIME DP - Unbound Medicine ER -