title: Early results of surgery in patients with nonfunctioning pituitary adenoma and analysis of the risk of tumor recurrence.
abstract: OBJECTIVE
  Nonfunctioning pituitary adenomas (NFPAs) are benign tumors of the pituitary gland that typically cause visual and/or hormonal dysfunction. Surgery is the treatment of choice, but patients remain at risk for tumor recurrence for several years afterwards. The authors evaluate the early results of surgery and the long-term risk of tumor recurrence in patients with NFPAs.
  
  
  METHODS
  Between 1990 and 2005, 491 previously untreated patients with NFPA underwent surgery at the Università Vita-Salute. Determinations of recurrence or growth of the residual tumor tissue during the follow-up period were based on neuroradiological criteria.
  
  
  RESULTS
  Residual tumor after surgery was detected in 173 patients (36.4%). Multivariate analysis showed that invasion of the cavernous sinus, maximum tumor diameter, and absence of tumor apoplexy were associated with an unfavorable surgical outcome. At least 2 sets of follow-up neuroimaging studies were obtained in 436 patients (median follow-up 53 months). Tumors recurred in 83 patients (19.0%). When tumor removal appeared complete, younger age at surgery was associated with a risk of tumor recurrence. In patients with incomplete tumor removal, adjunctive postoperative radiotherapy had a marked protective effect against growth of residual tumor.
  
  
  CONCLUSIONS
  Complete surgical removal of NFPAs can be safely achieved in > 50% of cases. Visual symptoms and, less frequently, pituitary function may improve after surgery. However, tumor can recur in patients after apparently complete surgical removal. In patients with incomplete tumor removal, radiation therapy is the most effective adjuvant therapy for preventing residual tumor growth.
authors.affiliation: The Pituitary Unit, Department of Neurosurgery, Istituto Scientifico San Raffaele, Università Vita-Salute, Milano, Italy. losa.marco@hsr.it
authors.forename: Marco
authors.initials: M
authors.lastname: Losa
authors.forename: Pietro
authors.initials: P
authors.lastname: Mortini
authors.forename: Raffaella
authors.initials: R
authors.lastname: Barzaghi
authors.forename: Paolo
authors.initials: P
authors.lastname: Ribotto
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Terreni
authors.forename: Stefania Bianchi
authors.initials: SB
authors.lastname: Marzoli
authors.forename: Sandra
authors.initials: S
authors.lastname: Pieralli
authors.forename: Massimo
authors.initials: M
authors.lastname: Giovanelli
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D018365:Neoplasm, Residual; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome