The Importance of Long-Term Follow-up after Endoscopic Pituitary Surgery: Durability of Results and Tumor Recurrence
Bibliographic record
Abstract
Introduction: Endoscopic transsphenoidal surgery (ETS) has become the preferred surgical approach for resection of pituitary adenomas in most centers. This technique has a series of advantages such as improved visualization and maneuverability when compared with microscopic transsphenoidal approach. However, long-term results are still scarce. Ten years ago, we published our initial series with short-term results. This project aims to revisit the results of that series, assessing now the long-term results regarding radiological recurrence of pituitary adenomas. Methods: Retrospective analysis of consecutive, endoscopically managed pituitary adenomas in a single center from 2004 to 2007. Only patients with >5 years of follow-up (FU) were included in this study. Results: A total of 98 patients matched the inclusion criteria for this study. The median follow-up period was 144 months. Nonfunctioning adenoma was the most common subtype ( n = 66, 67.3%), followed by GH-secreting tumors ( n = 19, 19.4%), ACTH-secreting tumors ( n = 7, 7.1%), prolactinomas ( n = 4, 4.1%), and TSH-secreting adenomas ( n = 2, 2%). Age ranges from 23 to 82 years, with median age of 53 years. Preoperative visual deficits were observed in 46 patients (46.9%) and hormonal deficits were identified in 31% of cases. 22.4% of patients had undergone a previous pituitary adenomas resection prior to treatment in our center. Surgery achieved gross total resection (GTR) and near-total resection in 86 cases (85%; 50 and 35%, respectively). A total of 37 cases had recurrences during FU (mean recurrence free survival: 80 months). Recurrences were observed in 32% of patients who had had GTR, with mean RFS of 87.25 months, while recurrences were observed in 41.9% of patients who underwent near-total or partial resection (mean RFS = 69.22 months). Most recurrences occurred after 5 years of FU (23 cases <63% of all recurrences) and only four cases had recurrences in the first 2 years after surgery. Surgery and/or radiation were done for management of recurrences in 29/37 cases. Cavernous sinus invasion and cases that had undergone previous surgery were significantly associated with shorter RFS, among which recurrent case was most significantly associated in multivariate analysis ( p = 0.05). Conclusion: Long-term FU analysis demonstrates that progression/recurrence of previously resected adenomas is observed in a significant number of patients, especially in those in whom GTR was not achieved. Short-term FU may shadow real tumor control rates achieved after ETS and therefore, long-term FU should be pursued in all cases.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.016 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".