Comparison of outcomes between intracapsular resection and pseudocapsule-based extracapsular resection for pituitary adenoma: a systematic review and meta-analysis

Xiang Zhang,Mincai Ma,Yan-Gang Wang,Guanjian Zhao,Jin Chen,Jiahe Tan,Ning Huang

doi:10.1186/s12883-022-02574-9

Abstract

BackgroundTranssphenoidal surgery is the preferred first-line therapy for most pituitary adenoma(PA), and the conventional strategy of treatment is intracapsular resection(IR). The protocol of extracapsular resection(ER), which considers the pseudocapsule as the PA boundary for surgical removal, has also been introduced gradually. In this study, the clinical efficacies and complications were explored and compared between these two procedures.MethodsA systematic literature review was performed in the PubMed, EMBASE, Web of Science and Cochrane databases. Articles comparing between IR and ER were included.ResultsThere were 7 studies containing 1768 cases in accordance with the inclusion criteria. Although the meta-analysis showed no significant difference in complete resection, a sensitivity analysis revealed that ER was more conducive to total PA resection than IR. Moreover, we found a significant difference in favor of ER regarding biochemical remission. Furthermore, there was no significant difference in the incidence rate of certain complications, such as hormone deficiency, diabetes insipidus, intraoperative cerebrospinal fluid(CSF) and postoperative CSF leakage. However, a sensitivity analysis suggested that IR decreased the risk of intraoperative CSF leakage.ConclusionsThis meta-analysis unveiled that ER contributed to biochemical remission. To some extent, our results also showed that ER played a positive role in complete resection, but that IR reduced the incidence of intraoperative CSF leakage. However, the available evidence needs to be further authenticated using well-designed prospective, multicenter, randomized controlled clinical trials.

Highlights

Transsphenoidal surgery is the preferred first-line therapy for most pituitary adenoma(PA), and the conventional strategy of treatment is intracapsular resection(IR)
In traditional endonasal transsphenoidal surgery, the Pituitary adenoma (PA) mass can be removed in an intracapsular fashion similar to internal decompression after opening the endocranium of the sellar floor, but the visual blind zones, dropping of residual tumor and expansion of the normal gland frequently result in failure of complete resection
Many pituitary adenomas are encased in a compressed, thin layer of normal pituitary tissues, which are defined as pseudocapsules [4]

Summary

Introduction

Transsphenoidal surgery is the preferred first-line therapy for most pituitary adenoma(PA), and the conventional strategy of treatment is intracapsular resection(IR). Pituitary adenoma(PA) is a common benign neoplasm with a morbidity of 115/100,000 that comprises 10 ~ 15% of primary tumors in the brain [1]. In traditional endonasal transsphenoidal surgery, the PA mass can be removed in an intracapsular fashion similar to internal decompression after opening the endocranium of the sellar floor, but the visual blind zones, dropping of residual tumor and expansion of the normal gland frequently result in failure of complete resection. The conflicting results have given rise to arguments that ER could be a source of injury to normal pituitary tissue and increased risks of complications [12]. It is not clear whether ER shows improved effectiveness and safety compared with IR

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