Surgical Outcome of Endoscopic Transsphenoidal Pituitary Adenoma Resection in Elderly Patients Compared to Younger Patients

Introduction: Increases in life expectancy, as well as the increase in pituitary adenoma incidence with age, will lead to large numbers of elderly patients presenting for treatment. Endoscopic transsphenoidal surgical resection has become the standard of practice in many centers for the treatment of symptomatic pituitary adenomas. Taken together, these trends lead to a larger number of elderly patients being considered for surgery. Although they are considered high risk for surgery, surgical outcomes in patients aged 80 years and older remain poorly characterized.

Methods: We conducted a retrospective chart review of all patients treated with endoscopic transsphenoidal surgery for pituitary adenoma between 2005 and 2019 at a single institution. A total of 686 patients met inclusion criteria, and were stratified into three age groups: a control group of <65 years (493 patients), comparison groups of 65 to 79 years (170 patients), and ≥80 years (23 patients). Tumor characteristics and outcomes were analyzed using Fisher’s exact test for categorical data, and student’s t-test for continuous data.

Results: Compared with the <65-year-old group, patients 65 to 79 years old were less likely to have a functional tumor (OR: 0.176, p < 0.001, 95% CI: 1.079–7.092), had a higher rate of macroadenoma versus microadenoma (OR: 2.771, p = 0.028, 95% CI: 0.141–0.927), and had higher rate of optic nerve compression/involvement (OR: 1.798, p = 0.004, 95% CI: 1.206–2.679). However, we observed no corresponding significant difference between the <65 age group and the ≥80 age group in the rate of functional tumors, macroadenoma, or optic nerve compression. There were no trends between <65-year-old patients and either the 65 to 79 years group or the ≥80 group with regard to gender, incidental tumor detection, primary versus recurrent tumor, cavernous sinus invasion, or pituitary apoplexy.

Intraoperatively, the 65 to 79 years age group had a lower CSF leak rate compared with the <65 group (OR: 0.617, p = 0.029, 95% CI: 0.398–0.955), although the ≥80 group showed no significant trend. There were no correlations between any groups in rate of nasoseptal flap reconstruction, patulous sellar diaphragm, extent of resection, postoperative length of stay, or 30-day readmission rate postoperatively. There was one perioperative mortality in the 65–79-year age group.

From an endocrinologic standpoint, the rate of new-onset postoperative thyroid insufficiency was higher in both the 65–79 age group (OR: 1.651, p = 0.043, 95% CI: 1.012–2.694) and the ≥80 age group (OR: 3.375, p = 0.024, 95% CI: 1.237–9.207) than in the <65 group. Interestingly, the rate of postoperative diabetes insipidus was lower in the 65–79 group (OR: 0.415, p = 0.042, 95% CI: 0.174–0.992) than in the <65 group, although there was no significant trend in the ≥80. There were no differences in postoperative rates of hypocortisolism, hypogonadism, or SIADH between groups. Diabetes insipidus and SIADH were no more likely to be permanent versus transient in any age group.

Conclusion: Transsphenoidal pituitary adenoma resection is a safe and effective intervention for elderly patients, including the growing cohort of patients over 80 years old. With comparable surgical outcomes and complications, advance age should not disqualify a patient as a surgical candidate.