Reported outcomes in transsphenoidal surgery for pituitary adenomas: a systematic review.

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Layard Horsfall, Hugo 
Lawrence, Alistair 
Venkatesh, Ashwin 
Loh, Ryan TS 
Jayapalan, Ronie 

PURPOSE: Transsphenoidal surgery is an established treatment for pituitary adenomas. We examined outcomes and time points following transsphenoidal surgery for pituitary adenoma to identify reporting heterogeneity within the literature. METHODS: A systematic review of studies that reported outcomes for transsphenoidal surgery for pituitary adenoma 1990-2021 were examined. The protocol was registered a priori and adhered to the PRISMA statement. Studies in English with > 10 patients (prospective) or > 500 patients (retrospective) were included. RESULTS: 178 studies comprising 427,659 patients were included. 91 studies reported 2 or more adenoma pathologies within the same study; 53 studies reported a single pathology. The most common adenomas reported were growth hormone-secreting (n = 106), non-functioning (n = 101), and ACTH-secreting (n = 95); 27 studies did not state a pathology. Surgical complications were the most reported outcome (n = 116, 65%). Other domains included endocrine (n = 104, 58%), extent of resection (n = 81, 46%), ophthalmic (n = 66, 37%), recurrence (n = 49, 28%), quality of life (n = 25, 19%); and nasal (n = 18, 10%). Defined follow up time points were most reported for endocrine (n = 56, 31%), extent of resection (n = 39, 22%), and recurrence (n = 28, 17%). There was heterogeneity in the follow up reported for all outcomes at different time points: discharge (n = 9), < 30 days (n = 23), < 6 months (n = 64), < 1 year (n = 23), and > 1 year (n = 69). CONCLUSION: Outcomes and follow up reported for transsphenoidal surgical resection of pituitary adenoma are heterogenous over the last 30 years. This study highlights the necessity to develop a robust, consensus-based, minimum, core outcome set. The next step is to develop a Delphi survey of essential outcomes, followed by a consensus meeting of interdisciplinary experts. Patient representatives should also be included. An agreed core outcome set will enable homogeneous reporting and meaningful research synthesis, ultimately improving patient care.


Funder: NIHR Cambridge Biomedical Research Centre; doi:

Funder: NIHR Biomedical Research Centre University College London

Funder: Royal College of Surgeons

Funder: Wellcome Trust (ISSF fund)

Adenoma, Core outcome sets, Neurosurgery, Outcome, Pituitary, Transsphenoidal, Humans, Pituitary Neoplasms, Retrospective Studies, Prospective Studies, Quality of Life, Treatment Outcome, Adenoma, Patient Reported Outcome Measures
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Springer Science and Business Media LLC
Wellcome / EPSRC Centre for Interventional and Surgical Sciences (NS/A000050/1, NS/A000050/1)