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

• Published in: Pituitary Vol. 26; no. 2; pp. 171 - 181
• Main Authors: Layard Horsfall, Hugo, Lawrence, Alistair, Venkatesh, Ashwin, Loh, Ryan T. S., Jayapalan, Ronie, Koulouri, Olympia, Sharma, Rishi, Santarius, Thomas, Gurnell, Mark, Dorward, Neil, Mannion, Richard, Marcus, Hani J., Kolias, Angelos G.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-04-2023; Springer Nature B.V
• Subjects: Adenoma; Adenoma - pathology; Adenoma - surgery; Adrenocorticotropic hormone; Endocrinology; Growth hormones; Human Physiology; Humans; Medicine; Medicine & Public Health; Pathology; Patient Reported Outcome Measures; Patients; Pituitary; Pituitary Neoplasms - pathology; Pituitary Neoplasms - surgery; Prospective Studies; Quality of Life; Retrospective Studies; Surgery; Surgical outcomes; Systematic review; Treatment Outcome; Tumors; Transsphenoidal; Core outcome sets; Neurosurgery; Adenoma; Pituitary; Outcome
• ISSN: 1386-341X; 1573-7403; 1573-7403
• DOI: 10.1007/s11102-023-01303-w

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.