Background: Multidisciplinary approach to pituitary disease is highly recommended; it requires a close relationship between expert pituitary surgeons and endocrinologists together with several specialists (e.g. neuroradiologists) in order to provide a high-level standard of care. Although there is evidence that neurosurgeons expertise is a key element to achieve better outcomes, also endocrinologists role is fundamental but it may sometimes encounter real-life barriers.
Aim of the study: To explore from a real-life database the impact of neurosurgical centre expertise on post-surgical outcomes in pituitary patients attending a tertiary academic medical centre.
Methods: A retrospective, observational, single-centre study was carried out including all patients attending the Endocrinology Unit of Modena (Italy) that underwent pituitary surgery from January 1995 to December 2020. For each patient, pre-operative features of the pituitary lesion, surgery information and post-surgical outcomes (i.e. residual neoplasia, surgery-related complications and pituitary function) were collected from record charts. Patients were grouped according to the expertise degree of the centre where they underwent surgery: Group1 included patients treated in neurosurgical centres with high expertise in pituitary surgery (defined as >50 transsphenoidal pituitary surgeries per year); Group2 included patients treated in neurosurgical centre performing <50 transsphenoidal pituitary surgeries per year.
Results: A total of 132 patients (67 men, 65 women; mean age at surgery 50.4±16.8 years) were included. Considering the histological diagnosis, 114 patients (86.4%) had a pituitary adenoma, 11 patients (8.3%) had a craniopharyngioma, and 7 patients (5.3%) had other rarer diagnoses. Group1 included 63 patients (47.7%) and Group2 included 69 patients (52.3%). A pre-surgical endocrinological evaluation was performed in almost all patients with adenoma (89.3%), and just only in 37.5% of patients with craniopharyngioma (P<0.001). Interestingly, patients without a pre-operative endocrinological evaluation were significantly more frequent in Group2 (26.3%) than Group1 (1.9%) (P<0.001). We analysed post-surgical outcomes focusing on pituitary adenoma patients. Patients in Group2 had an almost eight-fold increased likelihood to have residual neoplasia (OR: 8.53; 95% CI: 3.45-21.09) and five-fold increased likelihood to have hypopituitarism (OR: 5.53; 95% CI: 2.41-12.73), while no difference was found for post-surgical complications (9.6% in Group1 vs 22.4% in Group2; P=0.070).
Conclusions: This study confirms that high pituitary neurosurgical expertise is essential to achieve better post-surgical outcomes. The lack of pre-operative endocrinological evaluation is significantly associated to surgery performed in a not-experienced centre. A close multidisciplinary cooperation between experienced endocrinologists and neurosurgeons is required both before and after surgical procedures.
21 May 2022 - 24 May 2022