Outcomes of transsphenoidal surgery for pituitary adenomas in Spain: a retrospective multicenter study.

Fecha de publicación: 01/01/2025

Autores de IIS La Fe

Rosa Cámara Gómez

Autor

Participantes ajenos a IIS La Fe

Paja, Miguel
Soto, Alfonso
Hanzu, Felicia A
Guerrero-Perez, Fernando
Moure, Dolores
Galvez, Angeles
Simo-Servat, Andreu
Villar-Taibo, Rocio
Calatayud, Maria
Vicente, Almudena
Recio-Cordova, Jose M
Serra, Guillermo
Martin Rojas-Marcos, Patricia
Parra-Ramirez, Paola
Araujo-Castro, Marta
Librizzi, Soledad
Irigaray, Ana
Ollero, Dolores
Aznar, Silvia
Munoz, Fernando
Aulinas, Anna
Gonzalez-Fernandez, Laura
Garcia-Centeno, Rogelio
Egana, Nerea
Gonzalez-Vidal, Tomas
Menendez, Edelmiro
Delgado, Ana M
Abarca, Javier
Sottile, Johana
Pico, Antonio M
Novo, Cristina
Ortiz, Isabel
Tenorio, Carmen
de Leon, Ricardo
de Pablos-Velasco, Pedro
Crespo, Cristina
Penalver, David
Diaz-Soto, Gonzalo
Puig-Domingo, Manel
Biagetti, Betina

Grupos

Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética clínica

Leader

Juan Francisco Merino Torres

Abstract

Background: The outcomes of transsphenoidal surgery (TSS) for pituitary adenoma (PA) depend on many factors, including the availability of an expert team and the volume of surgeries performed. Data on the outcomes of TSS for PA are scarce in our country. TESSPAIN evaluates TSS outcomes in Spanish centers to assess the influence of surgical volume and specialized neurosurgical teams on success and complication rates. 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.