Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, ZA Leiden, The Netherlands.
Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands.
J Clin Endocrinol Metab. 2021 Aug 18;106(9):e3300-e3311. doi: 10.1210/clinem/dgab138.
Transsphenoidal surgery is standard care in the treatment of hormone-secreting pituitary adenomas. Current clinician-reported surgical outcome measures are one-dimensional, typically focusing primarily on complete or partial resection, and secondarily on complication rates. However, outcomes are best reflected by the delicate balance of efficacy and complications at patient level.
This study proposes a novel way to classify and report outcomes, integrating efficacy and safety at the patient level.
Retrospective chart review of all pure endoscopic transsphenoidal surgical procedures for acromegaly, Cushing's disease, and prolactinoma between 2010 and 2018 in a single tertiary referral center. We present our results in a classic (remission and complications separate) and in a novel outcome square integrating both outcomes, focusing on intended and adverse effects (long-term complications). This resulted in 4 outcome groups, ranging from good to poor. We use this approach to present these outcomes for several subgroups.
A total of 198 surgical procedures were included (44 reoperations). Remission was achieved in 127 operations (64%). Good outcome was observed after 121 (61%), and poor outcome after 6 (3%) operations. When intended effect of surgery was applied (instead of remission), good outcome as intended was achieved after 148 of 198 surgeries (75%) and poor outcome after 4 (2%).
Quality of a surgical intervention can be presented in 4 simple categories, integrating both efficacy and safety with flexibility to adapt to the individualized situation at patient, disease, and surgical strategy and to the outcome of interest.
经蝶窦手术是治疗激素分泌性垂体腺瘤的标准治疗方法。目前临床医生报告的手术结果指标是一维的，通常主要集中在完全或部分切除，其次是并发症发生率。然而，结果最好反映了患者层面上疗效和并发症之间的微妙平衡。
本研究提出了一种新的分类和报告结果的方法，将患者层面的疗效和安全性整合在一起。
回顾性分析了 2010 年至 2018 年期间在一家三级转诊中心进行的所有单纯内镜经蝶窦手术治疗肢端肥大症、库欣病和催乳素瘤的病例。我们以经典（缓解和并发症分开）和新颖的结果方格形式呈现我们的结果，重点关注预期和不良反应（长期并发症），将两者的结果整合在一起。这导致了 4 种结果组，从好到差。我们使用这种方法来呈现这些结果的几个亚组。
共纳入 198 例手术（44 例再次手术）。127 例手术达到缓解（64%）。121 例（61%）手术结果良好，6 例（3%）手术结果较差。当应用手术的预期效果（而不是缓解）时，198 例手术中有 148 例（75%）达到预期的良好效果，4 例（2%）效果较差。
手术干预的质量可以用 4 种简单的类别来表示，将疗效和安全性整合在一起，具有灵活性，可以适应患者、疾病和手术策略的个体化情况，以及感兴趣的结果。
