Outcomes of transsphenoidal surgery for pituitary adenomas in Spain: a retrospective multicenter study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Paja Miguel, Soto Alfonso, Hanzu Felicia A, Guerrero-Pérez Fernando, Cámara Rosa, Moure Dolores, Gálvez Ángeles, Simó-Servat Andreu, Villar-Taibo Rocío, Calatayud María, Vicente Almudena, Recio-Córdova Jose M, Serra Guillermo, Martín Rojas-Marcos Patricia, Parra-Ramírez Paola, Araujo-Castro Marta, Librizzi Soledad, Irigaray Ana, Ollero Dolores, Aznar Silvia, Muñoz Fernando, Aulinas Anna, González-Fernández Laura, García-Centeno Rogelio, Egaña Nerea, González-Vidal Tomás, Menéndez Edelmiro, Delgado Ana M, Abarca Javier, Sottile Johana, Picó Antonio M, Novo Cristina, Ortiz Isabel, Tenorio Carmen, de León Ricardo, de Pablos-Velasco Pedro, Crespo Cristina, Peñalver David, Díaz-Soto Gonzalo, Puig-Domingo Manel, Biagetti Betina
Аннотация
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.