Comparative Effectiveness of Different Surgical Approaches for Giant Pituitary Adenomas

NCT ID: NCT05448690

Last Updated: 2024-10-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

600 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-01-01

Study Completion Date

2023-01-01

Brief Summary

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The surgical treatment strategy for giant invasive pituitary adenoma is one of the current hot spots in the field of clinical research on pituitary adenoma. A comprehensive literature search resulted in numerous previous studies to investigate the efficacy, advantages and disadvantages of different surgical options.

A single approach (transnasal or craniotomy) is theoretically less invasive and has a shorter hospital stay for the patient, but may result in postoperative bleeding due to residual tumor and damage to the intracranial vessels adhering to the tumor.

The advantage of the combined approach is that the tumor can be removed to the greatest extent possible. In addition, postoperative suprasellar hemorrhage can be prevented by careful hemostasis or intracranial drainage by the transcranial team if necessary. In this way, the risk of postoperative bleeding due to residual tumor can be significantly reduced.

In some cases, waiting a few months after the initial surgery for a second-stage procedure may also be an option when the patient's condition does not allow for a combined access procedure, when the tumor is hard, or when the blood preparation is insufficient. However, staged surgery increases the financial burden on the patient, and local scar formation may make second-stage surgery more difficult and decrease the likelihood of endocrine remission of functional pituitary tumors.

Given the complexity of the treatment of giant invasive pituitary adenoma, there is a need to conduct studies comparing the combined transnasal cranial approach, the single access transnasal or cranial approach, and the staged approach simultaneously to assess whether the combined transnasal cranial approach is superior to the single access transnasal or cranial approach or the staged approach in improving the tumor resection rate in giant invasive pituitary adenoma.

Detailed Description

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Conditions

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Surgery Pituitary Adenoma

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Non-combined approach (Single or Staged)

Patients underwent transnasal approach or craniotomy approach; Patients underwent an initial surgery and a sencond staged surgery several months after the initial surgery

Group Type ACTIVE_COMPARATOR

Non-combined approach

Intervention Type PROCEDURE

Either transnasal, transcranial or a staged approach

Combined approach

Patients underwent a combined approach using transnasal approach and craniotomy approach simultaneously

Group Type EXPERIMENTAL

Two different approaches

Intervention Type PROCEDURE

Please refer to Groups

Interventions

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Two different approaches

Please refer to Groups

Intervention Type PROCEDURE

Non-combined approach

Either transnasal, transcranial or a staged approach

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Giant pituitary adenoma (\> 4cm in diameter)

Exclusion Criteria

* most of the tumor were in the sellae, sphenoidal sinus or clivus.
* patients with craniopharyngioma or meningioma.
Minimum Eligible Age

6 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Huashan Hospital

OTHER

Sponsor Role lead

Responsible Party

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Zhaoyun Zhang

Prof

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Chongqing People's Hospital

Chongqing, Chongqing Municipality, China

Site Status

The first affliated hospital of Fujian Medical Hospital

Fuzhou, Fujian, China

Site Status

The First Affiliated Hospital of Guizhou Medical University

Guiyang, Guizhou, China

Site Status

General hospital of Eastern Theater Command

Nanjing, Jiangsu, China

Site Status

The First Affiliated Hospital of China Medical University

Shenyang, Jilin, China

Site Status

General Hospital of Ningxia Medical University

Yinchuan, Ningxia, China

Site Status

The First Affiliated Hospital of Shandong First Medical University

Jinan, Shandong, China

Site Status

Huashan Hospital

Shanghai, Shanghai Municipality, China

Site Status

Shanghai General Hospital

Shanghai, Shanghai Municipality, China

Site Status

Shanghai Renji Hospital

Shanghai, Shanghai Municipality, China

Site Status

Changzhi People's Hospital

Changzhi, Shanxi, China

Site Status

The first hospital of Shanxi Medical University

Taiyuan, Shanxi, China

Site Status

The first affliated hospital of Kunming Medical University

Kunming, Yunnan, China

Site Status

Countries

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China

References

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Qiao N, Gao W, Deng X, Xin T, Zhang G, Wu N, Wang P, Bi Y, Cong Z, Zhou Z, Li J, Sun S, Li M, Tang W, Yan X, Wang W, Qiu W, Yao S, Ye Z, Ma Z, Zhou X, Cao X, Shen M, Shou X, Zhang Z, Wu Z, Chu L, Qiu Y, Ma H, Wu A, Ma C, Lou M, Jiang C, Wang Y, Zhao Y. Combined simultaneous transsphenoidal and transcranial regimen improves surgical outcomes in complex giant pituitary adenomas: a longitudinal retrospective cohort study. Int J Surg. 2024 Jul 1;110(7):4043-4052. doi: 10.1097/JS9.0000000000001330.

Reference Type DERIVED
PMID: 38498406 (View on PubMed)

Other Identifiers

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KY2022-060

Identifier Type: -

Identifier Source: org_study_id

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