Available online 10 December 2023, 108079

Author links open overlay panel, , , , , , , , , , , , , , , , , , , …ABSTRACTObjective

First-line prolactin-secreting tumor (PST) management typically involves treatment with dopamine agonists and the role of surgery remains to be further explored. We examined the international experience of 12 neurosurgical centers to assess the patient characteristics, safety profile, and effectiveness of surgery for PST management.

Methods

Patients surgically treated for PST from January 2017 through December 2020 were evaluated for surgical characteristics, outcomes, and safety.

Results

Among 272 patients identified (65.1% female), the mean age was 38.0±14.3 years. Overall, 54.4% of PST were macroadenomas. Minor complications were seen in 39.3% of patients and major complications were in 4.4%. The most common major complications were epistaxis and worsened vision. Most minor complications involved electrolyte/sodium dysregulation. At 3-6 months, local control on imaging was achieved in 94.8% of cases and residual/recurrent tumor was seen in 19.3%. Reoperations were required for 2.9% of cases. On multivariate analysis, previous surgery was significantly predictive of intraoperative complications (6.14 OR, p<0.01) and major complications (14.12 OR, p<0.01). Previous pharmacotherapy (0.27 OR, p=0.02) and cavernous sinus invasion (0.19 OR, p=0.03) were significantly protective against early endocrinological cure. Knosp classification was highly predictive of residual tumor or PST recurrence on 6-month follow-up imaging (4.60 OR, p<0.01). There was noted institutional variation in clinical factors and outcomes.

Conclusion

Our results evaluate a modern, multicenter, global series of PST. These data can serve as a benchmark to compare with DA therapy and other surgical series. Further study and longer term outcomes could provide insight into how patients benefit from surgical treatment.

Section snippetsINTRODUCTION

Representing approximately 40% of all pituitary adenomas, prolactin-secreting tumors (PST) arise from monoclonal proliferation of pituitary lactotrophs. [1] Symptoms of PSTs include decreased libido, hypogonadism, galactorrhea, male impotence/erectile dysfunction, and female oligomenorrhea/amenorrhea. [1] In addition to these disorders of hormonal imbalance, PSTs may exert mass effect and thereby cause headaches, seizures, intracranial hypertension, vision changes, and focal neurological

Data Source and Study Participants

The present study used a large international, multicenter, retrospectively collected dataset with 2,826 pituitary adenoma surgery patients from 12 neurosurgery centers of excellence (defined as institutions with extensive experience and the presence of multidisciplinary care teams) in North America, South America, Europe, and Asia. Surgeries were performed between January 2017 and December 2020. Institutional Board Review was acquired from each site independently. A central IRB was also

Demographics and Baseline Characteristics

Among 2,826 modern patients with pituitary adenomas in our multi-institutional study, a total of 272 patients with PSTs treated with surgery were identified, with representation from all 12 institutions (Fig. 1). The mean patient age was 38.0±14.3 years, and 177 (65.1%) patients were female (Table 1). Regarding previous hormone replacement therapy, 64 (23.5%) used levothyroxine, 27 (9.9%) used hydrocortisone, and 25 (9.2%) used other therapies. Neurological deficits were seen in 53 (19.5%) of

DISCUSSION

To the best of our knowledge, this is the largest multicenter cohort and second-largest overall cohort of patients with PSTs treated via resection. [13] In our study, disease remission was defined endocrinologically, and termination of tumor hypersecretion was achieved in 73.5% of patients, which is in line with other studies. [7], [14], [15] Early follow-up (3-6 months) revealed disease recurrence in 19.3% of patients, but reoperation was required in only 2.9% of patients. Our results

CONCLUSION

The results of our international, multicenter study demonstrate that surgery for PSTs is a generally safe and effective therapeutic modality to be used in conjunction with pharmacotherapy. Overall, the results showed a 94.8% local control rate and 73.5% rate of halting hypersecretion. Notable multivariate findings included previous pharmacotherapy and cavernous sinus invasion as independently protective against 3–6-month endocrinological cure, while previous pharmacotherapy and Knosp

Funding

This study did not receive any funding or financial support.

CRediT authorship contribution statement

Matthew C. Findlay: Formal Analysis, Writing - Original Draft; Mohammadmadhi Sabahi: Writing - Original Draft; Mohammed Azab: Formal Analysis, Writing - Original Draft; Richard Drexler: Resources, Writing - Review & Editing; Roman Rotermund: Resources, Writing - Review & Editing; Franz L. Ricklefs: Resources, Writing - Review & Editing; Jörg Flitsch: Resources, Writing - Review & Editing; Timothy R. Smith: Resources, Writing - Review & Editing; John L. Kilgallon: Resources, Writing - Review &

CRediT authorship contribution statement

Schroder Henry W.S.: Data curation, Writing – review & editing. Nasi-Kordhishti Isabella: Data curation, Writing – review & editing. Honegger Jürgen: Data curation, Writing – review & editing. Kilgallon John L.: Data curation, Writing – review & editing. Smith Timothy R.: Data curation, Writing – review & editing. Jane John A.: Data curation, Writing – review & editing. Abdallah Hussein M.: Data curation, Writing – review & editing. Gersey Zachary C.: Data curation, Writing – review & editing.

ACKNOWLEDGMENTS

We thank Drs. Alexandria C. Marino, Jamil A. Rzaev, Evgeniy V. Galushko, Ekaterina V. Gormolysova, and Anatoliy V. Bervitskiy for their contribution to the database. We thank Kristin Kraus, MSc, for editorial assistance.

Disclosures

The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Henry W.S. Schroeder has a financial relationship with Karl Storz SE & Co. KG.

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