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Transsphenoidal resection for pituitary adenoma in elderly versus younger patients: a systematic review and meta-analysis

Abstract

Introduction

Pituitary adenomas (PA) are common intracranial tumors. In the context of the aging of the population, the question is whether postsurgical outcomes are comparable to the younger ones. The primary objective of the present study was to review published resection and recurrence rates after transsphenoidal resection. The secondary aim was to evaluate visual improvement and complication rates.

Methods

The authors searched PubMed and Medline databases, of published English series, with no time frame limit, evaluating outcomes of transsphenoidal resection in populations aged more or less than 65, 70, and 80 years. We performed a systematic review and meta-analysis.

Results

Median overall resection rates for younger population was 70.7% (range 54–76.8) and for elderly one was 65.7% (range 16.6–78.2) (two-sample t test, p = 0.35). The only statistically significant difference for gross total resection rates (GTR) favored patients aged less than 80 (p = 0.01). There was no statistically significant difference among recurrence rates. There was a statistically significant difference for visual improvement favoring patients aged more than 80 (p = 0.03). For the age groups of less versus more than 70, there was a statistically significant difference for overall complication rate favoring younger groups (p < 0.05).

Conclusion

Present data shows GTR rates favoring younger patients. Recurrence rates remain similar over the mean follow-up period. Moreover, visual improvement favors patients aged more than 80. Overall complication rates favor patients younger than 70, which might be also related to additional comorbidities, frequently present in seniors. Transsphenoidal surgery is safe and effective even for older patients.

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Funding

Constantin Tuleasca gratefully acknowledges receipt of a “Young Researcher in Clinical Research Grant” (Jeune Chercheur en Recherche Clinique) from the Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), and the Lausanne University Hospital (CHUV).

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Tuleasca, C., Ducos, Y., Leroy, HA. et al. Transsphenoidal resection for pituitary adenoma in elderly versus younger patients: a systematic review and meta-analysis. Acta Neurochir 162, 1297–1308 (2020). https://doi.org/10.1007/s00701-020-04300-1

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Keywords

  • Elderly
  • Younger
  • Transsphenoidal
  • Resection
  • Meta-analysis