TY - JOUR
T1 - Biopsy Versus Subtotal Versus Gross Total Resection in Patients with Low-Grade Glioma
T2 - A Systematic Review and Meta-Analysis
AU - Yang, Kaiyun
AU - Nath, Siddharth
AU - Koziarz, Alex
AU - Badhiwala, Jetan H.
AU - Ghayur, Huphy
AU - Sourour, Michel
AU - Catana, Dragos
AU - Nassiri, Farshad
AU - Alotaibi, Mazen B.
AU - Kameda-Smith, Michelle
AU - Manoranjan, Branavan
AU - Aref, Mohammed H.
AU - Mansouri, Seyed Alireza
AU - Singh, Sheila
AU - Almenawer, Saleh A.
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/12
Y1 - 2018/12
N2 - Background: The role of the extent of surgical resection (EOR) in clinical outcomes for patients with low-grade glioma requires further examination. The goal of the present study was to evaluate the association between variable degrees of EOR and clinical outcomes for patients with low-grade glioma. Methods: We conducted a systematic review and meta-analysis and searched databases for reports of low-grade glioma EOR. Eligible studies compared patient outcomes, including ≥2 categories of EOR (biopsy, resection of any extent, subtotal resection [STR], or gross total resection [GTR]). Treatment effects were evaluated using pooled estimates, mean differences, or risk ratios (RRs) with corresponding 95% confidence intervals (CIs) using random effects modeling. Results: Our literature search yielded 60 studies with 13,289 patients. Pooled estimates of overall survival (OS) showed an increase from 3.79 years in the biopsy group to 6.68 years in STR to 10.65 years in GTR. OS was favorable with resection of any extent compared with (mean difference, 3.24; 95% CI, 0.64–5.84; P = 0.015). Pooled estimates of seizure control showed an improvement from 47.8% with biopsy to 54.2% with STR and 81.0% with GTR. Compared with STR, GTR delayed malignant transformation (RR, 0.43; 95% CI, 0.20–0.93; P = 0.032), without increasing postoperative mortality (RR, 0.38; 95% CI, 0.07–1.97; P = 0.250) or morbidity (RR, 1.22; 95% CI, 0.65–2.28; P = 0.540). Conclusion: Among patients with low-grade gliomas, greater degrees of safe EOR were associated with longer OS and progression-free survival, better seizure control, and delayed malignant transformation, without increasing mortality or morbidity.
AB - Background: The role of the extent of surgical resection (EOR) in clinical outcomes for patients with low-grade glioma requires further examination. The goal of the present study was to evaluate the association between variable degrees of EOR and clinical outcomes for patients with low-grade glioma. Methods: We conducted a systematic review and meta-analysis and searched databases for reports of low-grade glioma EOR. Eligible studies compared patient outcomes, including ≥2 categories of EOR (biopsy, resection of any extent, subtotal resection [STR], or gross total resection [GTR]). Treatment effects were evaluated using pooled estimates, mean differences, or risk ratios (RRs) with corresponding 95% confidence intervals (CIs) using random effects modeling. Results: Our literature search yielded 60 studies with 13,289 patients. Pooled estimates of overall survival (OS) showed an increase from 3.79 years in the biopsy group to 6.68 years in STR to 10.65 years in GTR. OS was favorable with resection of any extent compared with (mean difference, 3.24; 95% CI, 0.64–5.84; P = 0.015). Pooled estimates of seizure control showed an improvement from 47.8% with biopsy to 54.2% with STR and 81.0% with GTR. Compared with STR, GTR delayed malignant transformation (RR, 0.43; 95% CI, 0.20–0.93; P = 0.032), without increasing postoperative mortality (RR, 0.38; 95% CI, 0.07–1.97; P = 0.250) or morbidity (RR, 1.22; 95% CI, 0.65–2.28; P = 0.540). Conclusion: Among patients with low-grade gliomas, greater degrees of safe EOR were associated with longer OS and progression-free survival, better seizure control, and delayed malignant transformation, without increasing mortality or morbidity.
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U2 - 10.1016/j.wneu.2018.08.163
DO - 10.1016/j.wneu.2018.08.163
M3 - Article
C2 - 30172972
AN - SCOPUS:85054078992
SN - 1878-8750
VL - 120
SP - e762-e775
JO - World neurosurgery
JF - World neurosurgery
ER -