Prognosis of pituitary adenomas in the early 1970s and today-Is there a benefit of modern surgical techniques and treatment modalities?

Objective: Neurosurgical techniques for the treatment of sellar pathologies have been evolving continuously over the last decades. Additionally to the innovation of approaches and surgical techniques, this progress yielded to the application of modern intraoperative surgical tools as well as peri-and intraoperative imaging. Until now, no long-term analysis of the impact of new therapy concepts on the patient's outcome exists. Aim of this study was to analyse the impact of new operative approaches on perioperative mortality and morbidity as well as the long-term outcome after pituitary surgery. Patients and methods: Three groups of patients were compared in this retrospective analysis of surgically treated pituitary adenomas between the years of 1963 and 2014. Group A contains 93 patients, treated between 1963-1980 with a mean follow-up of 12.1 years (+/- 14.3 years), group B comprises 89 patients treated between 1990 and 2000 with a mean follow-up of 10.1 years (+/- 8.1 years) and group C consists of 95 patients treated between 2011-2014 with a mean follow-up of 3.4 years (+/- 1.9 years). Results: The surgical treatment was performed significantly earlier today on smaller tumors with less preoperative complaints (p < 0.01). Panhypopituitarism was detected only in 9.5% of the cases in group C compared to 50.8% in group A (p <0.01). Also, the incidence of revision surgery (5.6 vs. 2% vs 0%), postoperative hemorrhage (10.8% vs. 3.4% vs. 1%) and diabetes insipidus (34.4% vs. 11.2% vs. 5.2%) was decreased (p < 0.01). Moreover, a significant postoperative improvement of ophthalmological complaints was detected (p <0.001). The long-term follow-up showed 40% of the entire recurrence rate occurring after the ninth postoperative year. The progression-free survival time increased significantly from group A to group B (p <0.05). Conclusions: The results demonstrate a benefit of the recent developments of pituitary surgery in the short-term results as well as in the long-term outcome. The prognosis of pituitary adenoma patients could be improved by the introduction of new surgical approaches and techniques in the last decades. Also the perioperative morbidity and mortality rate has been reduced clearly since the 1970s. Furthermore our results emphasise the necessity of lifelong follow-up of all patients with successfully treated pituitary adenomas. (C) 2017 Elsevier B.V. All rights reserved.