THU086 Pituitary Post-Surgical Outcomes According To Neurosurgical Expertise: A Retrospective Study From A Tertiary Endocrinological Centre
Authors: De Vincentis Sara , Pederzoli Simone , Monzani Maria Laura , Bacchi Nicolò , Madeo Bruno , Diazzi Chiara , Rochira Vincenzo 
Published: October 2023

Abstract
Disclosure: S. De Vincentis: None. S. Pederzoli: None. M. Monzani: None. N. Bacchi: None. B. Madeo: None. C. Diazzi: None. V. Rochira: None.
BACKGROUND: Neurosurgeons’ expertise is a key element to achieve better pituitary outcomes. At present the impact of expertise has been investigated mainly on disease control in functioning pituitary adenomas. AIM: To explore from a real-life database the impact of neurosurgical centre expertise on post-surgical outcomes in patients with pituitary masses attending a tertiary academic medical centre. METHODOLOGY: A retrospective, observational, single-centre study was carried out including all patients attending the Endocrinology Unit of Modena (Italy) that underwent pituitary surgery from January 1995 to February 2022. Pre- and post-surgical data (i.e. tumor diameter, surgery-related complications and pituitary function) were collected from record charts. Patients were divided in two groups according to neurosurgical centre expertise: Low-Volume Centres (LVC) (less than 50 pituitary surgeries per year) and High-Volume Centres (HVC) (50 or more pituitary surgeries per year). RESULTS: A total of 125 enrolled patients (59 females; 66 males; median age 52) were grouped in LVC (67 patients, 54%) and HVC (58 patients, 46 %) groups according to neurosurgical centre expertise. At histology 106 patients (84.8%) had a pituitary adenoma, 10(8.0%) a craniopharyngioma, and 9 (7.2%) other rarer diagnoses. A pre-surgical endocrinological evaluation was performed more frequently in patients with adenoma (50%) than craniopharyngioma (11.3%) (p &lt;0.001). Pre-surgical endocrinological evaluation was significantly more frequently available in LVC (25.4%) than HVC (1.7%) (p &lt;0.001). Surgical approach was trans-sphenoidal in 90.4% of cases, with only few craniotomy (9.6%). No patients were approached with craniotomy in HVC group, compared to 17.9% of LVC group (p&lt;0.001). A post-surgical remnant was present in 72 patients (57.6%) and it was significantly more frequent in patients of LVC than HVC group (74.6% vs 37.9%, p&lt;0.001). At the binary logistic regression analysis, we found that patients of LVC group had an almost five-fold increased likelihood to have a postoperative residual lesion compared to HVC (OR 4.8; 95% CI: 2.2-10.3). Median percentage decrease from baseline was 76% [-8.2; 100] and it was significantly higher in patients of HVC than LVC group (p&lt;0.001). LVC patients had four-fold increased likelihood to have hypopituitarism (OR: 3.7; 95% CI: 1.7-7.8), while no difference was found for other post-surgical complications. CONCLUSIONS: This study demonstrates that post-surgical outcomes are better in neurosurgical centres with superior expertise. The lack of pre-operative endocrinological evaluation is significantly associated to surgery performed in a not-experienced centre. A close multidisciplinary cooperation between experienced endocrinologists and neurosurgeons is required both before and after surgical procedures.
Presentation: Thursday, June 15, 2023