Shall we be less aggressive in pituitary surgery in the elderly?
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Shall we be less aggressive in pituitary surgery in the elderly? Rafael Martinez‑Perez1 · Ricardo L. Carrau1,2 · Daniel M. Prevedello1,2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Dear Editor, We read with special interest the article by Tardivo et al. entitled “Surgery of pituitary adenomas: does age matter?”, recently published in a new issue of your journal [1]. Authors reported their results on a surgical series of 81 elderly patients with pituitary adenomas treated through an endoscopic endonasal approach (EEA) [1]. Although the authors did not find any differences in the outcomes variables, results of this work undoubtfully speak for the safety of the EEA for pituitary adenoma in elderly population. However, we would like to add some distilled thoughts to this well-written article, as we feel they will provide additional insight to one of the topics the authors are trying to address: the role of the partial resection of pituitary adenomas in the elderly population. From a statistical point of view, such analysis is challenging considering the low number of patients that are included in this series. As expected, none of the analyzed outcome variables showed any significant differences between age groups. We cannot exclude the possibility of achieving a significant p value by increasing the number of patients in each group, but that goal would require a much larger sample, and sub-analysis of multiple variables would increase the chances of obtaining spurious results. Additionally, the reported heterogeneity across different groups entails another source of bias. Do differences in the proportion gross/partial resection respond to an intraoperative decision by the main surgeon to reduce postoperative complications, or was it previously decided based in the preoperative * Rafael Martinez‑Perez [email protected] * Daniel M. Prevedello [email protected] 1
Present Address: Departments of Neurosurgery, Wexner Medical Center, The Ohio State University, 410 W. 10th Ave., N‑1049 Doan Hall, Columbus, OH 43210, USA
Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
2
imaging? Which factor was more strongly considered to take such a decision? We are aware that answers to these questions are particularly complicated to address in a retrospective analysis. However, such immeasurability impedes drawing any conclusions regarding the value of the partial resection in older patients. In addition, we would like to highlight the differences between authors opinion and conclusions that can strictly be drawn from the results obtained in their analysis. Authors stated: “a partial resection is preferred over a gross total one in order to reduce the surgical risk”. Such an assumption cannot be made, based on the methodology used in their manuscript, since direct comparisons between partial and radical resection was not even analyzed. Thus, it seems the aforementioned final statement just simply responds to an author’s ow
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