Robins James M W, Alavi Seyed A, Tyagi Atul K, Nix Paul A, Wilson Tom M, Phillips Nick I
Department of Neurosurgery, Leeds General Infirmary, G Floor, Jubilee Building, Leeds, LS1 3EX, UK.
Department of Ear, Nose and Throat (ENT) Surgery, Leeds General Infirmary, Leeds, UK.
Acta Neurochir (Wien). 2018 Jan;160(1):39-47. doi: 10.1007/s00701-017-3355-1. Epub 2017 Oct 23.
The object of this study was to assess whether increasing operative experience results in greater endoscopic trans-sphenoidal resection of pituitary macroadenomas and lower complications.
A retrospective single institution cohort study was performed. Subjects underwent endoscopic trans-sphenoidal resection of pituitary macroadenoma between July 2009 and July 2016 by three neurosurgeons. Following data collection, statistical analysis compared percentage of tumor resection and length of hospital stay (LOS) with experience. Complications including CSF leak are reported.
In total, 142 patients (87 male, 55 female) mean age 55.1 were included. Surgeon 1 performed 106 cases; surgeon 2 performed 23 cases; and surgeon 3 performed 13 cases. Mean pre-operative tumor volumes were 8.18 cm, 6.52 cm, and 3.47 cm and post-operative volumes were 2.21, 1.74, and 1.93 cm for surgeons 1, 2, and 3, respectively. Respective percentage resections were 74.3, 77.2, and 52.1%. Analysis demonstrated no difference in tumor resection with increasing experience for all three surgeons (p = 0.11, p = 0.17, and p = 0.26). Tumor consistency and cavernous sinus involvement did not appear to affect tumor resection. Mean LOS was 5 days, 4 days, and 3 days, respectively, with no significant correlation with experience for all three surgeons. Intraoperative CSF leak incidence was 19/106 (18%) for surgeon 1, 6/23(26%) for surgeon 2, and 2/13(15%) for surgeon 3. Primary closure rate was 96.3% and only three other complications occurred.
This study demonstrates that in our institution there is no statistically significant learning curve for the endoscopic resection of pituitary macroadenoma. However, there is a trend of improvement in tumor resection with experience for one surgeon. These findings suggest that the surgeons in our institution were capable of performing this procedure effectively with a low complication rate since adoption of the endoscopic technique in 2009.
本研究的目的是评估手术经验的增加是否会带来更大范围的垂体大腺瘤内镜经蝶窦切除术以及更低的并发症发生率。
进行了一项单机构回顾性队列研究。2009年7月至2016年7月期间，三名神经外科医生对受试者进行了垂体大腺瘤的内镜经蝶窦切除术。收集数据后，统计分析比较了肿瘤切除百分比和住院时间（LOS）与经验的关系。报告了包括脑脊液漏在内的并发症。
总共纳入了142例患者（男性87例，女性55例），平均年龄55.1岁。外科医生1进行了106例手术；外科医生2进行了23例手术；外科医生3进行了13例手术。外科医生1、2和3的术前平均肿瘤体积分别为8.18立方厘米、6.52立方厘米和3.47立方厘米，术后体积分别为2.21立方厘米、1.74立方厘米和1.93立方厘米。各自的切除百分比分别为74.3%、77.2%和52.1%。分析表明，对于所有三名外科医生，随着经验增加，肿瘤切除情况没有差异（p = 0.11、p = 0.17和p = 0.26）。肿瘤质地和海绵窦受累情况似乎不影响肿瘤切除。三名外科医生的平均住院时间分别为5天、4天和3天，与经验无显著相关性。外科医生1的术中脑脊液漏发生率为19/106（18%），外科医生2为6/23（26%），外科医生3为2/13（15%）。一期缝合率为96.3%，仅发生了其他三例并发症。
本研究表明，在我们机构，垂体大腺瘤内镜切除术不存在统计学上显著的学习曲线。然而，有一名外科医生的肿瘤切除情况有随经验改善的趋势。这些发现表明，自2009年采用内镜技术以来，我们机构的外科医生能够有效地进行该手术，且并发症发生率较低。
