1303. Endocrine and Recurrence Outcomes of Children with Gross Total versus Subtotal Resection of Craniopharyngioma: Systematic Review and Meta-analyses
Authors: Oluwaseun O. Akinduro, MD; Alessandro Izzo, MD; Victor Lu, MD, MS; Kaisorn Chaichana, MD (Jacksonville, FL)
The optimal surgical strategy for management of pediatric patients with craniopharyngioma remains controversial. While some advocate for gross total resection (GTR) with hopes of decreasing the risk for recurrence, others would advocate for subtotal resection (STR) with or without radiotherapy with hopes of preserving hormonal and functional status.
Titles and abstracts of published journals in the MEDLINE, EMBASE, Scopus, and Cochrane databases were searched from inception to July 19th 2018 for articles comparing post-operative endocrine function, vision, complications, and recurrence rates for adult patients with GTR and STR of craniopharyngioma. The articles were analyzed by meta-analysis of proportions using a random-effects model to calculate summary odds ratios (ORs).
Five studies were included in the final analyses with 51 patients in the GTR cohort and 61 patients in the STR cohort. For recurrence, compared to STR, GTR resulted in no significant difference in likelihood overall (OR, 0.528; 95% CI, 0.138-2.018; P<0.350). Pooled incidences of recurrence following GTR and STR were 26% (10/38) and 42% (14/33) respectively. For panhypopituitarism, compared to STR, GTR resulted in no significant difference in likelihood overall (OR, 0.968; 95% CI, 0.260-3.604; P=0.961). Pooled incidences of panhypopituitarism following GTR and STR were 41% (15/37) and 39% (17/44) respectively.
GTR does not result in worsened endocrine function when compared with patients who have STR of craniopharyngioma and STR does not result in increased recurrence when compared with patients who have GTR of craniopharyngioma. Surgeons should plan the operative strategy for each patient on a case-by-case basis.