Postoperative complications after endoscope-assisted transsphenoidal surgery for pituitary adenomas: a case series, systematic review, and meta-analysis of the literature

Stefanidis, Petros; Kyriakopoulos, Georgios; Athanasouli, Fani; Mytareli, Chrysoula; Georgios, Τzanis; Korfias, Stefanos; Stamatios, Theocharis; Angelousi, Anna

doi:10.1007/s42000-022-00362-1

Cited by 7 publications

(4 citation statements)

References 48 publications

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“…However, most reports focus more on the characteristics of tumor growth and surgical techniques which include pituitary gland and stalk manipulation during the operation [14]. As previously mentioned, larger tumor size, higher grade, pituitary apoplexy, multiple surgeries, and invasion of the dura or cavernous sinus are all risk factors for new pituitary dysfunction [38][39][40]. Compared with a microscope, the use of an endoscope may preserve pituitary function better with a similar degree of resection [41].…”

Section: Discussionmentioning

confidence: 99%

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

Nie

Fang

Wong

et al. 2022

Preprint

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Purpose： Currently, endoscopic transsphenoidal surgery is the main treatment for pituitary neuroendocrine tumors (PitNets). Excision of the tumor may have positive or negative effects on pituitary endocrine function and the pituitary function of somatotroph tumors is a point of particular concern after the operation. This study aimed to conduct a meta-analysis on the effect of endoscopic transsphenoidal somatotroph tumor resection on pituitary function. Methods： A systematic literature search was conducted for articles that included the evaluation of pituitary target gland before and after endoscopic transsphenoidal pituitary adenoma resection and published between 1992 and 2022 in PubMed, Cochrane, and Ovid MEDLINE. Results： 68 studies that included biochemical remission rates in 4524 somatotroph tumors were concluded. According to the 2000 consensus, the biochemical remission rate after transsphenoidal endoscopic surgery was 66.4% (95%CI,0.622-0.703; P = 0.000), the biochemical remission rate was 56.2% according to the 2010 consensus (95%CI,0.503-0.620; P = 0.041), and with the rate of biochemical remission ranging from 30.0% to 91.7% with investigator's definition. After endoscopic resection, adrenal axis dysfunction was slightly higher than that before surgery, but the difference was not statistically significant. Hypothyroidism was 0.712 times higher risk than that before surgery（OR=0.712; 95%CI, 0.527-0.961; P=0.027). Hypogonadism was 0.541 times higher risk than that before surgery (OR=0.541; 95%CI,0.393-0.746; P = 0.000). Hyperprolactinemia was 0.131 times higher risk than that before surgery (OR=0.131; 95%CI,0.022-0.783; P = 0.026). The incidence of pituitary insufficiency was 1.344 times risk before surgery after endoscopic resection of somatotroph tumors, but the difference was not statistically significant. Conclusions： Although the biochemical response rate of patients with transsphenoidal endoscopic growth hormone tumor resection will be increased as endoscopic surgery matures, some patients still require postoperative treatment, including gamma-ray therapy or drug take-in. Long-term follow-up and drug replacement therapy are required for newly diagnosed pituitary dysfunction, while the existing preoperative hypophysis can be ameliorated to some extent.

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Section: Discussionmentioning

confidence: 99%

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

Nie

Fang

Wong

et al. 2022

Preprint

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“…After autopsy in people who are not diagnosed with pituitary adenoma, it has been found that more than 10% of people had pituitary adenomas (Bing, 2021). Although most of pituitary adenoma are benign tumours and can be removed, the patients still have some uncomfortable symptoms after operation, resulting in impaired quality of life (Graffeo et al, 2022; Rosinha et al, 2022; Stefanidis et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Fatigue, sleep and physical activity in postoperative patients with pituitary adenomas: A survey

She,

Wu,

et al. 2024

Int J of Nursing Practice

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BackgroundThe condition and correlation of fatigue, sleep and physical activity in postoperative patients with pituitary adenomas remain unclear. This survey aimed to evaluate the current status and influencing factors of fatigue, sleep and physical activity in postoperative patients with pituitary adenomas.MethodsPatients undergoing pituitary adenoma resection in two tertiary hospitals from November 2019 to November 2021 were included. The general data questionnaire, Multidimensional Fatigue Inventory (MFI‐20), Pittsburgh Sleep Quality Index (PSQI) and international physical activity questionnaire were used for data analysis.ResultsIn total, 184 patients with pituitary adenomas were included. The postoperative patients with pituitary adenomas had a high level of fatigue. In total, 34 (18.5%) patients had low level of physical activity, 76(41.3%) patients had medium level of physical activity and 74 (40.2%) had high level of physical activity. Postoperative time, PSQI, physical activity level and gender were the influencing factors of fatigue in patients with pituitary adenomas (all P < 0.05).ConclusionsPostoperative patients with pituitary adenomas have a higher level of fatigue, and it is related to reduced sleep quality and activity. Relevant nursing measures should be taken according to the influencing factors of fatigue to reduce the fatigue of postoperative patients with pituitary adenomas.

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“…[6][7][8] Such complications, which can arise for a variety of risk factors not limited to the procedure that 9,10 result in returns to the operating room, prolonged hospital stays, and unplanned readmissions. 5,11,12 While the carcinogenic effects of tobacco smoke have been well-characterized, smoking tobacco has also been identified as a significant risk for poor healing and the need for reoperation after head and neck surgery. 13,14 One study of 165 endoscopic and open skull base surgeries has previously reported smoking to be a risk for 30-day readmission; however, this study excluded patients with pituitary adenomas.…”

Section: Introductionmentioning

confidence: 99%

A Comprehensive Analysis of Tobacco Smoking History as a Risk for Outcomes after Endoscopic Transsphenoidal Resection of Pituitary Adenoma

Min

Zhang

et al. 2023

J Neurol Surg B Skull Base

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Objectives: This study seeks to comprehensively analyze the impact of smoking history on outcomes after endoscopic transsphenoidal hypophysectomy (TSH) for pituitary adenoma. Design: Retrospective. Setting: Tertiary care center. Participants: 398 adult patients undergoing TSH for a pituitary adenoma. Main outcome measures: Clinical and tumor characteristics and operative factors were collected. Patients were categorized as never, former, or active smokers, and the pack-years of smoking history was collected. Years since cessation of smoking was obtained for former smokers. Specific outcomes included post-operative CSF leak, length of hospitalization, 30-day return to the operating room, and 30-day readmission. Smoking history details were comprehensively analyzed for association with outcomes. Results: Any history of smoking tobacco was associated with return to the operating room (OR=2.67, 95%CI: 1.05–6.76, p=0.039), which was for persistent CSF leak in 58.3%. Among patients with post-operative CSF leak, any history of smoking was associated with need for return to the operating room to repair the CSF leak (OR=5.25, 95%CI: 1.07–25.79, p=0.041). Pack-years of smoking was positively associated with a return to the operating room (OR=1.03, 95%CI: 1.01–1.06, p=0.048). In all multivariable models, all negative outcomes were significantly associated with the covariate occurrence of intra-operative CSF leak. Conclusion: This is the first study to show smoking may have a negative impact on healing of CSF leak repairs after TSH, requiring a return to the operating room. This effect appears to be dose-dependent on the smoking history. Secondarily, intra-operative CSF leak as covariate in multivariable models was significantly associated with all negative outcomes.

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Postoperative complications after endoscope-assisted transsphenoidal surgery for pituitary adenomas: a case series, systematic review, and meta-analysis of the literature

Cited by 7 publications

References 48 publications

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

Fatigue, sleep and physical activity in postoperative patients with pituitary adenomas: A survey

A Comprehensive Analysis of Tobacco Smoking History as a Risk for Outcomes after Endoscopic Transsphenoidal Resection of Pituitary Adenoma

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