Outcomes of surgically treated nonfunctioning pituitary adenomas

Abstract

INTRODUCTION: The sequelae of surgically treated non-functioning pituitary adenomas (NFPA) is an important area of study to help plan management. The aim was to study all Maltese patients who had a surgically treated NFPA and analyse the results of surgery, risk factors for tumour recurrence/regrowth and the role of postoperative radiotherapy.

MATERIALS AND METHODS: One hundred and seventy-five patients were identified as having a NFPA of whom 77 had underwent pituitary surgery. Detailed analysis of these patients was done including their demographic details, surgical details, post-surgical management, regrowth and recurrence patterns.

RESULTS: 63.6% of patients presented with visual field defects, 40.3% had headaches at presentation and 87.0% had chiasmal compression by their NFPA. Residual tumour postoperatively was evident in 67.5% of patients while 29.9% of patients had immediate postoperative radiotherapy. Recurrence /regrowth was documented in 18.2% of patients within a median time of 3.2 (IQR: 1.6–5.6) years. Factors that were found to be statistically significantly associated with a higher rate of regrowth using Kaplan-Meier estimates were the presence of residual tumour (P=0.036), presence of cavernous sinus invasion (P=0.034) and the lack of postoperative radiotherapy (P=0.004). Independent risk factors for tumour regrowth using multivariate Cox hazard analysis were absence of post-op radiotherapy (P=0.010) and cavernous sinus invasion (P=0.020).

CONCLUSION: By studying this cohort of patients we were able to characterise better the outcomes of NFPA management and outline risk factors which can effect prognosis.