J Neurol Surg B Skull Base 2020; 81(S 01): S1-S272
DOI: 10.1055/s-0040-1702527
Oral Presentations
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic versus Nonendoscopic Surgery for Resection of Pituitary Adenomas: A National Cancer Database Study

Khodayar Goshtasbi
1   Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, California, United States
,
Brandom M. Lehrich
2   University of California Irvine, Irvine, California, United States
,
Arash Abiri
1   Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, California, United States
,
Tyler Yasaka
2   University of California Irvine, Irvine, California, United States
,
Frank P. Hsu
3   Department of Neurological Surgery, University of California Irvine, Irvine, California, United States
,
Gilbert Cadena
3   Department of Neurological Surgery, University of California Irvine, Irvine, California, United States
,
Edward C. Kuan
1   Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, California, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
05 February 2020 (online)

 
 

    Background: For symptomatic nonsecreting pituitary adenomas, surgical resection remains a critical option for treatment. In this study, we utilize a large-population national database to compare endoscopic surgery (ES) to nonendoscopic surgery (NES) for surgical management of pituitary adenomas.

    Methods: The National Cancer Database (NCDB) was queried for all patients diagnosed with histologically confirmed pituitary adenoma from 2010 to 2015 with specified surgical approach. Due to limitations of NCDB, transsphenoidal microsurgery and craniotomy were both categorized as NES.

    Results: Of 30,488 identified patients undergoing surgical resection of pituitary adenomas with specified approach, 16,373 (53.7%) underwent ES and 14,115 (46.3%) underwent NES. There was a significant increase in ES utilization over time (R 2 = 0.903; p = 0.013). Compared with NES, ES patients were younger (p = 0.006), had smaller tumors (p<0.001), were Caucasian (p<0.001), had greater medical comorbidity burden (p = 0.043), had private insurance (p<0.001), were treated at an academic center (p<0.001), had higher household income (p<0.001), and lived a greater distance from their treatment site (p<0.001). Additionally, compared with NES, ES had lower rates of gross total resection (73.4 vs. 77.2%; p < 0.001), lower rates for adjuvant radiotherapy (3.5 vs. 4.5%; p<0.001), and shorter postoperative length of stay (3.7 ± 4.6 days vs. 4.3 ± 6.1 days; p<0.001). Though rates of 30-day readmission were similar (p = 0.085), ES had lower rates of both 30- (p = 0.002) and 90-day mortality (p<0.001). On multivariate logistic regression, African American race (OR: 0.852; 95% CI: 0.783–0.927, p<0.001) and tumor size above 2 cm (OR: 0.885; 95% CI: 0.825–0.950, p = 0.001) were less likely to be associated with receiving ES, while diagnosis at a more recent year (OR: 1.162; 95% CI: 1.141–1.185, p = 0.001), Charlson/Deyo score ≥1 (OR: 1.101; 95% CI: 1.025–1.184, p = 0.009), receiving treatment at an academic institution (OR: 1.673; 95% CI: 1.564–1.789, p<0.001), having private insurance (OR: 1.094; 95% CI: 1.002–1.170, p = 0.009), higher household income (OR: 1.112; 95% CI: 1.028–1.203, p = 0.008), and living greater than 20 miles distance from treatment site (OR: 1.167; 95% CI: 1.091–1.249, p<0.001) were associated with receiving ES.

    Conclusion: There is an increasing trend toward ES for pituitary adenoma resection. Factors such as tumor size, insurance, facility type, income, race, and existing comorbidities may predict receiving ES. Rates of gross total resection and the need for adjuvant therapy may differ between ES and NES approaches.


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    No conflict of interest has been declared by the author(s).