Pituitary Tumor Surgery in the Elderly: Perioperative Complications and Long-Term Outcome

Introduction: With an ageing population, the number of elderly patients with symptomatic pituitary tumors continues to increase. There is concern that increasing age in addition to patient co-morbidities results in increased perioperative complications and affects long-term outcome.

Methods: Retrospective analysis of the presentation, perioperative, and long-term outcome of patients older than the age of 70 years undergoing transsphenoidal pituitary surgery.

Results: Included in the study are 75 patients (age range, 70–94 years). Average follow-up was 30 months (range, 2–84months). Fifty-two patients underwent microscopic resection and the rest endoscopic. Visual field deficit (85%) and single pituitary hormone deficiency (72.1%) were the most common presentations. Sixty-six patients (88%) had additional co-morbidities, and 26 (34.6%) were on anticoagulants. One perioperative mortality and two anaesthesia-related complications (severe hypotension at induction) occurred. A small percentage of patients had an extended postoperative stay due to confusion (5.3%), urinary retention (5.3%), epistaxis (5.3%), SIADH (10.6%), DI (4%), and infection (pneumonia and urinary tract (4%). Twenty-six patients (34.6%) noticed complete resolution in field defect, with 44 (58.6%) showing partial improvement. One patient's vision deteriorated; 15 (20%) had additional hormone deficiency (IGF-1, TSH, and ACTH), requiring replacement therapy; and 3 (4%) had new onset DI at 6 weeks postoperation. Biochemical cure was achieved in all four patients with functioning tumors (three growth hormone acromegalies and one ACTH). Residual tumor with stable appearance on follow-up MRI occurred in 83.6% patients, and 8.1% showed growth of the tumor with only 2 (2.6%) requiring further surgery for worsening vision. None required radiotherapy.

Conclusions: Transsphenoidal surgery can be safely performed in patients older than the age of 70 years.