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Endoscopic transsphenoidal surgery for biochemically and clinically non-functioning adenohypophyseal tumours in the elderly: experience from a single UK centre

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Abstract

Purpose

To assess and compare outcome of surgical management of non-functioning pituitary adenohypophyseal tumours in patients under 65-years, and 65-years and older at tertiary neurosurgical referral centre.

Methods

Data was retrospectively analysed from pituitary database. Forty-four patients aged 65 or older (Group 1) and 93 patients under 65 (Group 2) underwent endoscopic trans-sphenoidal surgery (ETSS) between January 2017 and July 2019. The surgical, endocrinological, ophthalmological and radiological outcomes were compared.

Results

6.8% of Group 1 patients had peri-operative surgical complications compared to 12.9% in Group 2 (p = 0.29). Improved visual fields and acuity were seen in 65.2% and 82.8% of Group 1 and Group 2 respectively (p = 0.124), although there were pre-existing ocular problems in 15.9% of Group 1. New hormone deficiencies were observed in 31.8% of Group 1 patients, and 24.7% of Group 2 (p = 0.555). Tumour regrowth/recurrence was seen in 2.3% of Group 1 (p = 0.553). The rate of repeat surgery was 6.8% in the Group 1 and 12.9% in Group 2 (p = 0.28). There was no significant relationship between extent of resection, complications or hormonal deficiency. The mean duration of follow-up was 10.5 ± 13.0 months for Group 1 patients and 13.0 ± 16.0 months for Group 2 patients (p = 0.526).

Conclusions

ETSS for non-functioning pituitary adenohypophyseal tumours is safe and well tolerated in the patients aged 65 and older. Advanced age by itself should not be a contra-indication for ETSS. It is however highly recommended that the care of such patients to be offered at a high volume, dedicated pituitary surgical units.

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Data availability

This study was registered as a clinical audit and approved by the local hospital institutional review board. Ethics approval was not required as this was not a clinical trial requiring consent from human subjects. No patient derived images, video clips or articles were used in this study.

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Acknowledgements

We would like to thank Mr. Calvin Heal for his input and assistance with the statistical analysis section of this paper.

Author contributions

B.L.Q., A.E.B., K.K.: Substantial contribution to the conception and design of the study and draughting the manuscript. A.E.B., B.L.Q., F.R., H.V.: Acquisition of data. A.E.B., B.L.Q.: Analysis, and interpretation of data. K.G., O.P., F.R., T.K., J.B.: Critical revision of the manuscript for relevant intellectual content. K.K.: Critical revision of the manuscript and agreement to be accountable for accuracy and integrity of the study. Final approval of the version to be published.

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Authors and Affiliations

  1. Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK

    Boon Leong Quah, Andrew Edwards-Bailey, Kanna Gnanalingham, Omar Pathmanaban, Hariclea Vasilopoulos, James Balogun & Konstantina Karabatsou

  2. Geoffrey Jefferson Brain Research Centre, Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK

    Omar Pathmanaban, Federico Roncaroli & Konstantina Karabatsou

  3. Neuropathology Unit, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK

    Federico Roncaroli

  4. Department of Endocrinology, Salford Royal Hospital NHS Foundation Trust, Manchester, UK

    Tara Kearney

  5. Division of Neurosurgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria

    James Balogun

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  1. Boon Leong Quah
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Correspondence to Konstantina Karabatsou.

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Quah, B.L., Edwards-Bailey, A., Gnanalingham, K. et al. Endoscopic transsphenoidal surgery for biochemically and clinically non-functioning adenohypophyseal tumours in the elderly: experience from a single UK centre. Endocrine 75, 872–882 (2022). https://doi.org/10.1007/s12020-021-02910-y

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