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Combined simultaneous transsphenoidal and transcranial regimen improves surgical outcomes in complex giant pituitary adenomas: A longitudinal retrospective cohort study

医学 养生 回顾性队列研究 倾向得分匹配 外科 优势比 队列 置信区间 内科学
作者
Na Qiao,Wei Gao,Xingli Deng,Tao Xin,Gangli Zhang,Nan Wu,Pan Wang,Yunke Bi,Cong Zhang,Zhiyi Zhou,Jun Li,Shibin Sun,Muzhen Li,Wenlong Tang,Yan Xi,Wen‐Xiong Wang,W.-C. Chou,Shun Yao,Yanli Zhao,Zengyi Ma,Xiang Zhou,Xiaoyun Cao,Ming Shen,Xuefei Shou,Zhaoyun Zhang,Zhenyu Wu,Liangzhao Chu,Yongming Qiu,Hongjuan Ma,Anhua Wu,Chiyuan Ma,Meiqing Lou,Changzhen Jiang,Yongfei Wang,Yao Zhao
出处
期刊:International Journal of Surgery [Wolters Kluwer]
标识
DOI:10.1097/js9.0000000000001330
摘要

Surgical treatment of complex giant pituitary adenomas (GPAs) presents significant challenges. The efficacy and safety of combining transsphenoidal and transcranial approaches for these tumors remain controversial. In this largest cohort of patients with complex GPAs, we compared the surgical outcomes between those undergoing a combined regimen and a non-combined regimen. We also examined the differences in risks of complications, costs, and logistics between the two groups, which might offer valuable information for the appropriate management of these patients.This was a multicenter retrospective cohort study conducted at 13 neurosurgical centers. Consecutive patients who received a combined or non-combined regimen for complex GPAs were enrolled. The primary outcome was gross total resection, while secondary outcomes included complications, surgical duration, and relapse. A propensity score-based weighting method was used to account for differences between the groups.Out of 647 patients (298 [46.1%] women, mean age: 48.5 ± 14.0 years) with complex GPAs, 91 were in the combined group and 556 were in the non-combined group. Compared with the non-combined regimen, the combined regimen was associated with a higher probability of gross total resection (50.5% vs. 40.6%, odds ratio [OR]: 2.18, 95% confidence interval [CI]: 1.30-3.63, P = 0.003). The proportion of patients with life-threatening complications was lower in the combined group than in the non-combined group (4.4% vs. 11.2%, OR: 0.25, 95% CI: 0.08-0.78, P = 0.017). No marked differences were found between the groups in terms of other surgical or endocrine-related complications. However, the combined regimen exhibited a longer average surgery duration of 1.3 h (P < 0.001) and higher surgical costs of 22,000 CNY (approximate 3,000 USD, P = 0.022) compared with the non-combined approach.The combined regimen offered increased rates of total resection and decreased incidence of life-threatening complications, which might be recommended as the first-line choice for these patients.
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