Non-functioning pituitary macroadenomas: factors affecting postoperative recurrence, and pre- and post-surgical endocrine and visual function.
BACKGROUND
Non-functioning pituitary macroadenomas (NFPAs) with visual field defects are ideally managed by transsphenoidal tumour resection to improve vision, and long-term postsurgical follow up is necessary to monitor for tumour recurrence. Regular updates from global data are necessary for developing optimal management strategies of these tumours.


METHODS
Pre- and postoperative visual and endocrine profile, imaging characteristics and details of surgical interventions among patients with NFPAs managed between 2008 and 2019 in a UK regional centre were assessed. The radiological and surgical outcomes including postoperative complications, recurrence risk and the factors influencing outcomes also were assessed.


RESULTS
105 cases with mean (SD) age 60.1 (14.3) years and follow-up duration 60 (37) months were studied. 67 (64%) patients were male. Five-year recurrence-free survival rate was 71.5% (95% confidence interval [CI] 62.7% to 81.6%) with 33 (31%) tumour recurrences of whom 20 (60%) received radiotherapy and 9 (27%) underwent further surgery. Younger age, tumour volume, and bilateral cavernous sinus extension were the predictors of recurrence on univariate analysis, while younger age was the only factor on multivariate analysis (Hazard ratio 0.95; 95% CI: 0.92, 0.97). 72/78 patients (92%) with preoperative visual field defects improved after surgery, of whom 27 (35%) had full recovery. 20 (24%) patients had recovery of an abnormal hormone axis. 15 patients (16%) developed perioperative complications such as cerebrospinal fluid leak (12 cases), meningitis (2 cases), and bleeding (2 cases).


CONCLUSIONS
Five-year recurrence-free survival after transsphenoidal resection for NFPAs was 71.5% with older age at surgery conferring lower risk of recurrence. Visual recovery/ improvement occurred in 92% of cases with preoperative visual defects following surgery.
['Subramanian|Venkatram|V|', 'Lee|Rachel Su Min|RSM|', 'Howell|Simon|S|', 'Gregson|Samuel|S|', 'Lahart|Ian M|IM|', 'Kaushal|Kalpana|K|', 'Pappachan|Joseph M|JM|0000-0003-0886-5255']
D000236:Adenoma D000368:Aged D006801:Humans D008297:Male D008875:Middle Aged D009364:Neoplasm Recurrence, Local D010911:Pituitary Neoplasms D011183:Postoperative Complications D012189:Retrospective Studies D016896:Treatment Outcome D014785:Vision, Ocular
Non-functioning pituitary macroadenoma (NFPA) Visual field defect Recurrence-free survival Transsphenoidal resection