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作者

Nidan Qiao, Wei Gao, Xingli Deng, Tao Xin, Gangli Zhang, Nan Wu, Pan Wang, Yunke Bi, Zixiang Cong, Zhiyi Zhou, Junjun Li, Shengyu Sun, Meng Li, Wenlong Tang, Xiaorong Yan, Wenxiong Wang, Wenjin Qiu, Shun Yao, Zhao Ye, Zengyi Ma, Xiang Zhou, Xiaoyun Cao, Ming Shen, Xuefei Shou, Zhaoyun Zhang, Zhenyu Wu, Liangzhao Chu, Yongming Qiu, Hui Ma, Anhua Wu, Chiyuan Ma, Meiqing Lou, Changzhen Jiang, Yongfei Wang, Yao Zhao

作者单位

Affiliations ¹ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University. ² National Center for Neurological Disorders. ³ State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University. ⁴ Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration. ⁵ Neurosurgical Institute of Fudan University, Shanghai. ⁶ Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning. ⁷ Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan. ⁸ Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong. ⁹ Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi. ¹⁰ Department of Neurosurgery, Chongqing General Hospital, Chongqing. ¹¹ Department of Neurosurgery, Shanghai General Hospital, Shanghai. ¹² Department of Neurosurgery, Affiliated Jinling Hospital, Medicine School of Nanjing University, Nanjing, Jiangsu. ¹³ Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai. ¹⁴ Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia. ¹⁵ Department of Neurosurgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi. ¹⁶ Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian. ¹⁷ Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou. ¹⁸ Department of Endocrinology, Huashan Hospital, Fudan University. ¹⁹ School of Public Health, Fudan University. ²⁰ National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.

刊名

International journal of surgery (London, England)

年份

2024

卷号

Vol.110 No.7

页码

4043-4052

ISSN

1743-9159

摘要

Background: Surgical treatment of complex giant pituitary adenomas presents significant challenges. The efficacy and safety of combining transsphenoidal and transcranial approaches for these tumors remain controversial. In this largest cohort of patients with complex GPAs, we compared the surgical outcomes between those undergoing a combined regimen and a non-combined regimen. We also examined the differences in risks of complications, costs, and logistics between the two groups, which might of...更多

Background: Surgical treatment of complex giant pituitary adenomas presents significant challenges. The efficacy and safety of combining transsphenoidal and transcranial approaches for these tumors remain controversial. In this largest cohort of patients with complex GPAs, we compared the surgical outcomes between those undergoing a combined regimen and a non-combined regimen. We also examined the differences in risks of complications, costs, and logistics between the two groups, which might offer valuable information for the appropriate management of these patients. Patients and methods: This was a multicenter retrospective cohort study conducted at 13 neurosurgical centers. Consecutive patients who received a combined or non-combined regimen for complex GPAs were enrolled. The primary outcome was gross total resection, while secondary outcomes included complications, surgical duration, and relapse. A propensity score-based weighting method was used to account for differences between the groups. Results: Out of 647 patients [298 women, mean age: 48.5 ± 14.0 years] with complex GPAs, 91 were in the combined group and 556 were in the noncombined group. Compared with the noncombined regimen, the combined regimen was associated with a higher probability of gross total resection [50.5% vs. 40.6%, odds ratio : 2.18, 95% confidence interval : 1.30-3.63, P = 0.003]. The proportion of patients with life-threatening complications was lower in the combined group than in the non-combined group . No marked differences were found between the groups in terms of other surgical or endocrine-related complications. However, the combined regimen exhibited a longer average surgery duration of 1.3 h and higher surgical costs of 22,000 CNY compared with the noncombined approach. Conclusions: The combined regimen offered increased rates of total resection and decreased incidence of life-threatening complications, which might be recommended as the first-line choice for these patients.收起

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