The learning curve of endoscopic endonasal transsphenoidal surgery for pituitary adenomas with different surgical complexity

作者：Jinxiang Huang, Xinjie Hong, Zheng Cai, Qian Lv, Ying Jiang, Wei Dai, Guohan Hu, Yong Yan, Juxiang Chen, Xuehua Ding · 发表于：Frontiers in Surgery · 年份：2023 · DOI：10.3389/fsurg.2023.1117766 · 被引用次数：7 · 研究领域：Pituitary Gland Disorders and Treatments、Meningioma and schwannoma management、Head and Neck Surgical Oncology

Objective To investigate the learning curve under different surgical complexity in endoscopic transsphenoidal approach for pituitary adenoma. Methods 273 patients undergoing endoscopic transsphenoidal surgery for pituitary adenoma were collected retrospectively and divided into three groups chronologically (early, middle, and late periods). Surgical complexity was differentiated based on Knosp classification (Knsop grade 0–2 vs. Knosp grade 3–4), tumor maximum diameter (MD) (macroadenomas vs. giant adenomas), and history of previous surgery for pituitary adenoma (first operation vs. reoperation). Then the temporal trends in operative time, surgical outcomes, and postoperative complications were evaluated from early to late. Results The median operative time decrease from 169 to 147 min across the three periods ( P = 0.001). A significant decrease in operative time was seen in the simple groups [Knosp grade 0–2 adenoma (169 to 137 min, P < 0.001), macroadenoma (166 to 140 min, P < 0.001), and first operation (170.5 to 134 min, P < 0.001)] but not in their complex counterparts ( P > 0.05). The GTR rate increased from 51.6% to 69.2% ( P = 0.04). The surgical period was an independent factor for GTR in the simple groups [Knosp grade 0–2 adenoma: OR 2.076 (95%CI 1.118–3.858, P = 0.021); macroadenoma: OR = 2.090 (95%CI 1.287–3.393, P = 0.003); first operation: OR = 1.809 (95%CI 1.104–2.966, P = 0.019)] but not in the complex groups. The biochemical cure ...