Abstract
Object
While transsphenoidal surgical resection (TSSR) is important second-line therapy in prolactinoma patients, predictors of surgical cure and biochemical remission following TSSR remain sparse.
Methods
A retrospective review of prolactinoma patients undergoing TSSR at the USC Pituitary Center from 1995-2020 was conducted. Subjects were categorized as surgical cure (normalization of serum prolactin without medical treatment), surgical non-cure, biochemical control (prolactin normalization with or without adjuvant therapy), and non-biochemical control. A systematic review of the outcomes of surgically-managed prolactinomas was performed.
Results
The 40 females and 16 males had an average age of 35.6 years. Prior treatment included transsphenoidal resection (6, 11%) and DA treatment (47, 84%). The 40 macroadenomas and 15 microadenomas exhibited suprasellar extension (24, 43%) and parasellar invasion (20, 36%). Fifteen (27%) were purely intrasellar. Gross total resection was achieved in 25 patients (45%) and subtotal in 26 (46%). Surgical cure was achieved in 25 patients (46%) and biochemical control in 35 (64%). Surgical cure was more likely in smaller, noninvasive tumors, those that were fully resected, and patients with lower pre- (<1000ng/mL) and immediately postoperative (<7.6ng/mL) prolactin levels. Ten of 26 patients (38%) undergoing adjuvant therapy achieved biochemical control, which was less likely in males and those with higher preoperative prolactin or invasive tumors.
Conclusion
Surgical resection of prolactinomas is a safe procedure that, when offered judiciously, can achieve symptom and/or biochemical control in a majority of patients. A variety of predictors may be useful in advising patients on likelihood of postoperative remission.