Transsphenoidal resection for pituitary adenoma in elderly versus younger patients: a systematic review and meta-analysis

Abstract

Introduction: Pituitary adenomas (PA) are common intracranial tumors. In the context of the ageing of the population, the question is whether postsurgical outcomes are comparable to the younger ones. The primary objective of the present study was to review published resection and recurrence rates after transsphenoidal resection. The secondary aim was to evaluate visual improvement and complication rates. Methods: The authors searched PubMed and Medline databases, of published English series, with no time frame limit, evaluating outcomes of transsphenoidal resection in populations aged more or less than 65, 70 and 80 years. We performed a systematic review and meta-analysis. Results: Median overall resection rates for younger population was 70.7% (range 54-76.8) and for elderly one was 65.7% (range 16.6-78.2) (two sample t test, p= 0.35). The only statistically significant difference for gross total resection rates (GTR) favored patients aged less than 80 (p=0.01). There was no statistically significant difference among recurrence rates. There was a statistically significant difference for visual improvement favoring patients aged more than 80 (p=0.03). For the age groups of less versus more than 70, there was a statistically significant difference for overall complication rate favoring younger groups (p<0.05). Conclusion: Present data shows GTR rates favoring younger patients. Recurrence rates remain similar over mean follow-up period. Moreover, visual improvement favors patients aged more than 80. Overall complications rates favors patients younger than 70, which might be also related to additional comorbidities, frequently present in seniors. Transsphenoidal surgery is safe and effective even for older patients.

Surgical indications and outcomes of the endoscopic endonasal approach for brain tumors in older adults in Korea: a retrospective study

“…Dehydroepiandrosterone, growth hormone, and insulin-like growth factor-1 also decrease with age [31,32]. Recognizing the natural changes in hormones and distinguishing them from preoperative endocrinological deficiencies while considering the potential for postoperative recovery are crucial for determining surgical indications [13,29]. Reports suggest that hormonal recovery is not related to age, and the results of this study showed a 12.6% recovery rate, consistent with previous findings [12,17].…”

“…Previous reports have shown that the recovery of visual impairment scores was not different between older patients and younger patients, but the degree of improvement was different. Interestingly, although visual impairment scores were not obtained in this study, 70.6% of patients' vision appeared to improve, which is not dissimilar from what was previously reported [13,14].…”

“…For NF-PAs, previous reports have shown that macroadenomas can increase tumor volume and may lead to symptoms such as visual disturbance, pituitary apoplexy, and endocrine dysfunction [26,27]. Therefore, surgical decisions should be based on predicting life expectancy and the likelihood of symptom development in elderly patients [10][11][12][13][14][15][16]21,26,28,29]. Endocrinological status changes with age in elderly patients.…”

“…[7]. The transsphenoidal approach (TSA) has been used in the elderly population worldwide, but its feasibility and complications have been discussed [8][9][10][11][12][13][14][15][16]. This study was conducted to investigate the safety and effectiveness of TSA in the elderly population.…”

Validation of a clinicopathological prognostic score for elderly patients undergoing endoscopic endonasal surgery for pituitary adenoma: a single center 10 years’ experience and review of the literature

“…A decreasing rate of GTR with advancing age could be considered obvious. Indeed, different studies have highlighted an extent of resection similar [19,33,44] or even increased in older patients compared to younger ones [26, 28], without registering an increase in postoperative complications. Exceptionally, Thakur et al[28] have reported a higher percentage of intraoperative and postoperative CSF leak in young elderly (< 75 years old) despite a decreased extent of resection.…”