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The role of surgical management for prolactin-secreting tumors in the era of dopaminergic agonists: An international multicenter report
Journal article   Peer reviewed

The role of surgical management for prolactin-secreting tumors in the era of dopaminergic agonists: An international multicenter report

Matthew C. Findlay, Mohammadmahdi Sabahi, Mohammed Azab, Richard Drexler, Roman Rotermund, Franz L. Ricklefs, Jörg Flitsch, Timothy R. Smith, John L. Kilgallon, Jürgen Honegger, …
Clinical neurology and neurosurgery, v 236, 108079
01 Jan 2024
DOI: https://doi.org/10.1016/j.clineuro.2023.108079
PMID: 38091700
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Adenoma Prolactinoma Dopamine Surgery
First-line prolactin-secreting tumor (PST) management typically involves treatment with dopamine agonists and the role of surgery remains to be further explored. We examined the international experience of 12 neurosurgical centers to assess the patient characteristics, safety profile, and effectiveness of surgery for PST management. Patients surgically treated for PST from January 2017 through December 2020 were evaluated for surgical characteristics, outcomes, and safety. Among 272 patients identified (65.1% female), the mean age was 38.0 ± 14.3 years. Overall, 54.4% of PST were macroadenomas. Minor complications were seen in 39.3% of patients and major complications were in 4.4%. The most common major complications were epistaxis and worsened vision. Most minor complications involved electrolyte/sodium dysregulation. At 3–6 months, local control on imaging was achieved in 94.8% of cases and residual/recurrent tumor was seen in 19.3%. Reoperations were required for 2.9% of cases. On multivariate analysis, previous surgery was significantly predictive of intraoperative complications (6.14 OR, p < 0.01) and major complications (14.12 OR, p < 0.01). Previous pharmacotherapy (0.27 OR, p = 0.02) and cavernous sinus invasion (0.19 OR, p = 0.03) were significantly protective against early endocrinological cure. Knosp classification was highly predictive of residual tumor or PST recurrence on 6-month follow-up imaging (4.60 OR, p < 0.01). There was noted institutional variation in clinical factors and outcomes. Our results evaluate a modern, multicenter, global series of PST. These data can serve as a benchmark to compare with DA therapy and other surgical series. Further study and longer term outcomes could provide insight into how patients benefit from surgical treatment. •Minor complications were seen in 39.3% of patients and prior surgery predicted intraoperative complications.•Local tumor control at 3–6 months was seen in 94.8% of patients.•Previous pharmacotherapy and cavernous sinus invasion worsened remission at 3–6 months.•Termination of hypersecretion/hormone normalization was seen in 73.5% of patients.

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9 citations in Web of Science
4 citations in Scopus

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UN Sustainable Development Goals (SDGs)

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Clinical Neurology
Surgery
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