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Remission rate varies by hormone type in pituitary adenoma reoperation
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A second transsphenoidal surgery for pituitary adenoma can result in remission in approximately half of cases with secreting tumors, with higher success rates in nonsecreting tumors, according to a recent systematic review.
“The presence of residual tumor and tumor recurrence in the postoperative period are not uncommon,” Lindolfo Carlos Heringer, of the department of neurosurgery at Hospital do Servidor Público Estadual in São Paulo, and colleagues wrote. “Treatment of both conditions remains subject to individual selection since no established guidelines on the type of treatment option for these cases is currently available. In addition, it is well known that risks are higher in patients subjected to repeated transsphenoidal surgery than in patients without prior therapy. Thus, it is important to conduct a critical analysis of the effect of repeated surgery.”
Heringer and colleagues conducted a pooled analysis of 15 studies analyzing the effects of repeated transsphenoidal surgery in adults with pituitary adenoma. Studies included one randomized trial with 26 patients in each arm, and 14 pooled cohort studies evaluating 509 patients who underwent reoperation without a control group. Length of follow-up varied from 2 to 149 months (mean follow-up time, 32.1 months).
Researchers found that patients with nonsecreting tumors had a 76.1% remission rate (n = 173); patients with adrenocorticotropic hormone-secreting tumors had a 55.5% remission rate (n = 273); patients with growth hormone-secreting tumors had a 44.5% remission risk (n = 149). Researchers found no differences between microscopic and endoscopic techniques in surgery (remission rate of 56.5% vs. 54.9%, respectively).
Researchers noted that remission criteria varied among the included studies, and no studies described long-term follow-up.
“Some recurrences may be delayed, particularly with Cushing’s disease,” the researchers wrote. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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