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. 2023 Apr;26(2):171-181.
doi: 10.1007/s11102-023-01303-w. Epub 2023 Mar 2.

Reported outcomes in transsphenoidal surgery for pituitary adenomas: a systematic review

Hugo Layard Horsfall  1   2   3 , Alistair Lawrence  4 , Ashwin Venkatesh  5 , Ryan T S Loh  5 , Ronie Jayapalan  6 , Olympia Koulouri  7 , Rishi Sharma  8 , Thomas Santarius  6 , Mark Gurnell  7 , Neil Dorward  9 , Richard Mannion  6 , Hani J Marcus  9   10 , Angelos G Kolias  6
Affiliations

Reported outcomes in transsphenoidal surgery for pituitary adenomas: a systematic review

Hugo Layard Horsfall et al. Pituitary. 2023 Apr.

Abstract

Purpose: Transsphenoidal surgery is an established treatment for pituitary adenomas. We examined outcomes and time points following transsphenoidal surgery for pituitary adenoma to identify reporting heterogeneity within the literature.

Methods: A systematic review of studies that reported outcomes for transsphenoidal surgery for pituitary adenoma 1990-2021 were examined. The protocol was registered a priori and adhered to the PRISMA statement. Studies in English with > 10 patients (prospective) or > 500 patients (retrospective) were included.

Results: 178 studies comprising 427,659 patients were included. 91 studies reported 2 or more adenoma pathologies within the same study; 53 studies reported a single pathology. The most common adenomas reported were growth hormone-secreting (n = 106), non-functioning (n = 101), and ACTH-secreting (n = 95); 27 studies did not state a pathology. Surgical complications were the most reported outcome (n = 116, 65%). Other domains included endocrine (n = 104, 58%), extent of resection (n = 81, 46%), ophthalmic (n = 66, 37%), recurrence (n = 49, 28%), quality of life (n = 25, 19%); and nasal (n = 18, 10%). Defined follow up time points were most reported for endocrine (n = 56, 31%), extent of resection (n = 39, 22%), and recurrence (n = 28, 17%). There was heterogeneity in the follow up reported for all outcomes at different time points: discharge (n = 9), < 30 days (n = 23), < 6 months (n = 64), < 1 year (n = 23), and > 1 year (n = 69).

Conclusion: Outcomes and follow up reported for transsphenoidal surgical resection of pituitary adenoma are heterogenous over the last 30 years. This study highlights the necessity to develop a robust, consensus-based, minimum, core outcome set. The next step is to develop a Delphi survey of essential outcomes, followed by a consensus meeting of interdisciplinary experts. Patient representatives should also be included. An agreed core outcome set will enable homogeneous reporting and meaningful research synthesis, ultimately improving patient care.

Keywords: Adenoma; Core outcome sets; Neurosurgery; Outcome; Pituitary; Transsphenoidal.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA Flow Diagram demonstrating inclusion of studies
Fig. 2
Fig. 2
Outcome domains reported by studies, and if outcome domain reported was the primary outcome of the study. TSS transsphenoidal surgery, EOR extent of resection, QoL quality of life
Fig. 3
Fig. 3
Summary of surgical complications, endocrine and visual outcomes. a Summary of surgical complications outcomes, b Summary of endocrine outcome, c Summary of visual outcomes
See this image and copyright information in PMC

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