Study On Related Factors For Recurrence Following Transnasal Surgery For Pituitary Adenoma

Objective:Pituitary adenoma is the most common disease among sellar region lesions, and transnasal surgery for pituitary adenoma has become popular in the treatment of pituitary adenoma.But surgeon and patients have plenty of troubles for its high recurrence rate.The objective of this study was to determine the factors influencing recurrence following transnasal surgery for pituitary adenoma, then to provide more effective treatment for patients with pituitary adenoma and reduce the postoperative recurrence rate. Methods:We performed a retrospective review of 102 patients with pituitary adenomas undergoing transnasal surgery between January 2004 to January 2011 in Tianjin Huanhu Hospital. Demographic data, patient sex,age at diagnosis, tumor type and size, invasion and type of operation, post-operative adjuvant therapy, Pituitary apoplexy and CT or MRI findings were evaluated in each patient. We used logistic regression analyses after ascertaining that the assumptions of these models were fulfilled. Chi-square test was performed to analyze if there was a difference of recurrence rate between intracavernous and extracavernous in the patients with residual tumor. Fisher Exact Test was performed to analyze the relationship between clinical symptoms and recurrence rate. Results:Over a media follow-up peridd of 49.5 months(range 4-60),21(20.5%)of these patients showed recurrence.While no statistically significant effects of gender,age at diagnosis,type of tumer,tumor maximum diameter or the type of tool were seen, pituitary apoplexy, total resection,tumor invasion and adjunct therapy after operation were significant factors for recurrence(p=0.029,0.001,0.033, 0.023,respectively).Furthermore,when the subset of patients with post-operative residual tumor is analyzad separately,it’s found that the anatomical location of residual tumor(within or outside the cavernous sinus) was not associated with increased risk of recurrence( p=0.288).In the patients of functional pituitary adenoma,presentation with amenorrhea has an higher recurrence rate than others.This increased risk of recurrence with increased tumor size is consistent with our results showing a significant risk of recurrence especially in tumors with a maximum diameter greater than 10 mm. Conclusions:Long-term follow-up results of our study suggest that factors of recurrence following transnasal surgery for pituitary adenoma including pituitary apoplexy, total resection, invasion and adjunct therapy after operation. It has no obvious relevance between postoperative recurrence and patient sex,age at diagnosis, tumor type and size, type of operation.Surgeon can according to the conclusions to make effective feasible method to reduce and prevent recurrence following surgery of pituitary adenoma.