The optimal numerosity of the referral population of pituitary tumors centers of excellence (PTCOE): A surgical perspect
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The optimal numerosity of the referral population of pituitary tumors centers of excellence (PTCOE): A surgical perspective Pietro Mortini 1 & Gianluca Nocera 1 & Francesca Roncelli 1 & Marco Losa 1 & Anna Maria Formenti 2 & Andrea Giustina 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Surgical experience is of paramount importance to reach therapeutic success and minimize operative complications. In the field of pituitary surgery, this led to the concept of Pituitary Center of Excellence (PTCOE) defined as a center where an interdisciplinary team works in collaboration and where surgeons can be trained appropriately to reach and keep excellence in daily practice. To review the literature to define the optimal referral population size to establish a PTCOE to optimize both training and specific field research. A review of the literature was performed about epidemiology. The time needed to observe 200 cases of PAs in a single PTCOE and to reach the minimal surgical experience threshold (MSET) was calculated for different referral population groups. The time needed to reach MSET decreased as population size increased. We defined a population as the optimal one to be served by a single PTCOE with a single dedicated neurosurgeon. PTCOEs should be established after an analysis of the referral population, number of cases suitable for surgical treatment and number of dedicated neurosurgeons. Keywords Learning curve . Pituitary tumor center of excellence . Pituitary surgery . Pituitary adenomas
1 Introduction Pituitary adenomas (PAs) are benign tumors that arise from the adenohypophysis. They are the third most common brain tumor accounting for 10–15% of all CNS neoplasms [1]. PAs are classified by size and hormonal secretion. Microadenomas are smaller than 1 cm and macroadenomas are larger than 1 cm. They may cause clinical syndromes of hormone hypersecretion or symptoms of pituitary deficiency because of compression of the normal pituitary [2]. PAs may present with neurologic symptoms such as visual defects, headache, and diplopia, due to the mass effect on surrounding nervous structures or as an incidental finding on a radiologic examination performed for other reasons [2]. The epidemiology of pituitary tumors is still a matter of debate. According to the latest data reported in the literature,
* Pietro Mortini [email protected] 1
Division of Neurosurgery and Gamma-Knife Radiosurgery, San Raffaele Scientific Insitute, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
2
Division of Endocrinology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
the prevalence and incidence of PAs are far higher than those previously reported [3–10]. Surgery is the treatment of first choice for all PAs, except for prolactinomas [11–13]. For the latter, dopamine agonists are recommended as primary treatment as they are effective in lowering prolactin levels and decreasing adenoma size, while surgery is recommended in those patients not re
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