Outcomes of transsphenoidal surgery for pituitary adenomas in Spain: a retrospective multicenter study
Por:
Paja, M, Soto, A, Hanzu, FA, Guerrero-Pérez, F, Cámara, R, Moure, D, Gálvez, A, Simó-Servat, A, Villar-Taibo, R, Calatayud, M, Vicente, A, Recio-Córdova, JM, Serra, G, Rojas-Marcos, PM, Parra-Ramírez, P, Araujo-Castro, M, Librizzi, S, Irigaray, A, Ollero, D, Aznar, S, Muñoz, F, Aulinas, A, González-Fernández, L, García-Centeno, R, Egaña, N, González-Vidal, T, Menéndez, E, Delgado, AM, Abarca, J, Sottile, J, Picó, AM, Novo, C, Ortiz, I, Tenorio, C, de León, R, de Pablos-Velasco, P, Crespo, C, Peñalver, D, Díaz-Soto, G, Puig-Domingo, M, Biagetti, B
Publicada:
21 feb 2025
Resumen:
Background The outcomes of transsphenoidal surgery (TSS) for pituitary adenoma (PA) depend on many factors, including the availability of an expert team and the volume of surgeries performed. Data on the outcomes of TSS for PA are scarce in our country. TESSPAIN evaluates TSS outcomes in Spanish centers to assess the influence of surgical volume and specialized neurosurgical teams on success and complication rates. Methods A retrospective, nationwide, study of Spanish centers performing TSS between January 2018 and December 2022. Centers were classified as high volume (HV) [n=11, defined as centers with recognized expertise in Spain or those performing more than 25 TSS/year] or non-HV. Data collection included surgical success rates, complications, and pituitary adenoma resectability (R-PA). Additional analyses evaluated the impact of dedicated neurosurgical teams (DNT) within HV centers. Results A total of 2815 TSS from 29 Spanish centers were included (1421 NSPA, 436 GH-secreting, 323 Cushing's disease, 127 PRL-secreting and 25 TSH-secreting PA). The overall success rate was 50.5%, 76.8% for R-PA. HV centers had a higher overall success rate (53.1 vs. 47.7%; p=0.03). Better TSS outcomes for NSPA accounted for this difference. The overall TSS complication rate was 22.1%, which was higher for NSPA than for SPA (25.0 vs. 17.7%). The overall complication rate of TSS for PA was significantly higher in non-HV centers than in HV centers (24 vs 20.4.0; p <0.01). Centers with a DNT showed a trend to higher success rate in R-PA, while having a lower overall incidence of complications in TSS for PA than HV centers without a DNT (18.5 vs. 23.0; p=0.058), mainly reducing the rate of permanent ADH deficiency in all TSS for PA (2.7 vs. 8.4%; p<0.001). Conclusion Higher surgical volume and DNT are associated with improved TSS outcomes for PA in Spain. Our results support the recommendation of concentration of pituitary surgery in a reduced number of centers of expertise in our country in order to improve the success rate and reduce complications, mainly postoperative ADH deficiency.
Filiaciones:
Paja, M:
Hosp Univ Basurto, Dept Endocrinol & Nutr, Bilbao, Spain
Univ Basque Country UPV EHU, Med Dept, Bilbao, Spain
Soto, A:
Hosp Univ Virgen Rocio, Endocrinol & Nutr Dept, Seville, Spain
Hanzu, FA:
IDIPAS, Hosp Clin, Endocrinol & Nutr Dept, Barcelona, Spain
Guerrero-Pérez, F:
Hosp Univ Bellvitge, Dept Endocrinol & Nutr, Barcelona, Spain
Cámara, R:
La Fe Univ Hosp, Dept Endocrinol & Nutr, Valencia, Spain
Moure, D:
Hosp Univ Cruces, Endocrinol & Nutr Dept, Baracaldo, Bizkaia, Spain
Gálvez, A:
Hosp Univ Reina Sofia, Dept Endocrinol & Nutr, Cordoba, Spain
Simó-Servat, A:
Hosp Univ Mutua Terrassa, Dept Endocrinol & Nutr, Terrassa, Spain
Villar-Taibo, R:
Hosp Univ Santiago De Compostela, Dept Hematol, Santiago De Compostela, Spain
Calatayud, M:
Hosp Univ 12 Octubre, Dept Endocrinol & Nutr, Madrid, Spain
Vicente, A:
Hosp Univ Toledo, Endocrinol & Nutr Dept, Toledo, Spain
Recio-Córdova, JM:
Hosp Univ Salamanca, Endocrinol & Nutr Dept, Salamanca, Spain
Serra, G:
Hosp Univ Son Espases, Endocrinol & Nutr Dept, Mallorca, Spain
Rojas-Marcos, PM:
Hosp Univ La Paz, Endocrinol & Nutr Dept, Madrid, Spain
Parra-Ramírez, P:
Hosp Univ La Paz, Endocrinol & Nutr Dept, Madrid, Spain
Araujo-Castro, M:
Hosp Univ Ramon & Cajal, Endocrinol & Nutr Dept, Madrid, Spain
Librizzi, S:
Hosp Univ 12 Octubre, Dept Endocrinol & Nutr, Madrid, Spain
Irigaray, A:
Hosp Univ Navarra, Dept Endocrinol & Nutr, Dept Endocrinol & Nutr, Pamplona, Spain
Ollero, D:
Hosp Univ Navarra, Dept Endocrinol & Nutr, Dept Endocrinol & Nutr, Pamplona, Spain
Aznar, S:
Hosp Univ Albacete, Endocrinol & Nutr Dept, Albacete, Spain
Muñoz, F:
St Pau Hosp, Neurosurg Dept, Barcelona, Spain
Aulinas, A:
Hosp Santa Creu & Sant Pau, Endocrinol & Nutr Dept, Barcelona, Spain
González-Fernández, L:
Hosp Gregorio Maranon, Endocrinol & Nutr Dept, Madrid, Spain
García-Centeno, R:
Hosp Gregorio Maranon, Endocrinol & Nutr Dept, Madrid, Spain
Egaña, N:
Donostia Univ Hosp, Dept Neurol, Donostia San Sebastian, Spain
González-Vidal, T:
Hosp Univ Cent Asturias, Dept Endocrinol & Nutr, Oviedo, Asturias, Spain
Menéndez, E:
Hosp Univ Cent Asturias, Dept Endocrinol & Nutr, Oviedo, Asturias, Spain
Delgado, AM:
Hosp Univ Burgos, Endocrinol & Nutr Dept, Burgos, Spain
Abarca, J:
Hosp Gen Univ Alicante, Dept Neurosurg, Alicante, Spain
Sottile, J:
Hosp Gen Univ Alicante, Dept Endocrinol, Alicante, Spain
Picó, AM:
Hosp Gen Univ Alicante, Dept Endocrinol, Alicante, Spain
Novo, C:
Hosp Univ Granada, Dept Endocrinol & Nutr, Granada, Spain
Ortiz, I:
Hosp Univ Granada, Dept Neurosurg, Granada, Spain
Tenorio, C:
Hosp Univ Granada, Dept Endocrinol & Nutr, Granada, Spain
de León, R:
Hosp Dr Negrin Las Palmas De Gran Canaria, Dept Pathol, Las Palmas Gran Canaria, Spain
de Pablos-Velasco, P:
Hosp Dr Negrin Las Palmas De Gran Canaria, Dept Pathol, Las Palmas Gran Canaria, Spain
Crespo, C:
Hosp Clin Univ Valladolid, Dept Endocrinol & Nutr, Valladolid, Spain
Peñalver, D:
Hosp Clin Univ Valladolid, Dept Endocrinol & Nutr, Valladolid, Spain
Díaz-Soto, G:
Hosp Clin Univ Valladolid, Dept Endocrinol & Nutr, Valladolid, Spain
Puig-Domingo, M:
Hosp Badalona Germans Trias & Pujol, Dept Endocrinol & Nutr, Badalona, Spain
Biagetti, B:
Hosp Univ Vall dHebron, Dept Endocrinol & Nutr, CIBERER U747 ISCIII, Barcelona, Spain
Green Submitted, gold
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