Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, W1CN 3BG, UK.
Pituitary. 2023 Apr;26(2):171-181. doi: 10.1007/s11102-023-01303-w. Epub 2023 Mar 2.
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.
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.
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).
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.
经蝶窦手术是治疗垂体腺瘤的一种既定方法。我们研究了经蝶窦手术治疗垂体腺瘤的结果和时间点，以确定文献中的报告异质性。
对 1990 年至 2021 年期间报告经蝶窦手术治疗垂体腺瘤结果的研究进行了系统回顾。该方案预先进行了注册，并遵循 PRISMA 声明。纳入了英语发表的、有>10 例患者（前瞻性）或>500 例患者（回顾性）的研究。
共纳入 178 项研究，包括 427659 例患者。91 项研究在同一研究中报告了 2 种或以上的腺瘤病理学；53 项研究报告了单一病理学。报告最多的腺瘤是生长激素分泌型（n=106）、无功能型（n=101）和 ACTH 分泌型（n=95）；27 项研究未说明病理学。手术并发症是最常报告的结果（n=116，65%）。其他领域包括内分泌（n=104，58%）、切除范围（n=81，46%）、眼科（n=66，37%）、复发（n=49，28%）、生活质量（n=25，19%）和鼻腔（n=18，10%）。内分泌（n=56，31%）、切除范围（n=39，22%）和复发（n=28，17%）的随访时间点报告最多。在不同的时间点，所有结果的随访报告都存在异质性：出院（n=9）、<30 天（n=23）、<6 个月（n=64）、<1 年（n=23）和>1 年（n=69）。
过去 30 年来，经蝶窦手术切除垂体腺瘤的结果和随访报告存在异质性。本研究强调有必要制定一个稳健的、基于共识的、最低限度的核心结果集。下一步是开发一个基于德尔菲法的重要结果调查，然后是一个跨学科专家共识会议。还应包括患者代表。达成一致的核心结果集将能够实现同质报告和有意义的研究综合，最终改善患者护理。
