Surgical outcomes in recurrent glioma

Jason M. Hoover, Macaulay Nwojo, Ross Puffer, Jayawant Mandrekar, Fredric B. Meyer, Ian F Parney

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Object. The object of this study was to assess outcomes after surgery for recurrent intracranial glioma. Methods. The authors retrospectively reviewed cases involving adult patients with intracranial glioma patients undergoing initial surgery (biopsy or resection) and one or more additional surgeries at their institution. Results. A total of 323 operations were performed in 131 patients. The median survival was 76 months after first surgery, 36 months after second, 24 months after third, and 26.5 months after 4 or more surgeries. The overall complication rate was 12.8% after first surgery, 27.0% after second (OR 2.52, p = 0.0068), 22.0% after third (OR 1.92, not statistically significant [NS]), and 22.2% after 4 or more (OR 1.95, NS). Neurological complications occurred in 4.8% of patients at first surgery, 12.1% at second (OR 2.7, p = 0.0437), 8.2% at third (OR 1.75, NS), and 11.1% at 4 or more surgeries (OR 2.4583, NS). Regional complications occurred in 6.2% after first surgery, 9.9% after second surgery (OR 2.30, p = 0.095), 13.7% after third surgery (OR 3.31, p = 0.015), and 22.2% after 4 or more surgeries (OR 5.95, p = 0.056). Systemic complications occurred in 3.2% after first surgery, in 7.3% after second surgery (OR 2.3, p = 0.NS), in 4.1% after third surgery (OR 1.3, NS), and 0% after 4 or more surgeries. Reduction in Karnofsky Performance Status score occurred in 0% after first surgery, 8.1% after second surgery (OR 3.13, p = 0.0018), 10.2% after third surgery (OR 5.52, p < 0.0001), and 11.1% after 4 or more surgeries (OR 1.037, NS). Conclusions. Postoperative survival is relatively prolonged but complication risk increases in patients with glioma who undergo multiple cranial surgeries. The largest increase in neurological risk occurs between the first and second surgery. In contrast, regional complication risk increases consistently with each surgery. The risk of systemic complications is not significantly altered with increasing surgeries. However, these complications only result in a modestly increased risk of functional decline after 2 or more surgeries. These findings may help counsel patients considering multiple glioma surgeries.

Original languageEnglish (US)
Pages (from-to)1224-1231
Number of pages8
JournalJournal of Neurosurgery
Volume118
Issue number6
DOIs
StatePublished - Jun 2013

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Glioma
Karnofsky Performance Status

Keywords

  • Biopsy
  • Complication
  • Craniotomy
  • Glioma
  • Oncology
  • Outcome
  • Recurrent
  • Resection

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Surgical outcomes in recurrent glioma. / Hoover, Jason M.; Nwojo, Macaulay; Puffer, Ross; Mandrekar, Jayawant; Meyer, Fredric B.; Parney, Ian F.

In: Journal of Neurosurgery, Vol. 118, No. 6, 06.2013, p. 1224-1231.

Research output: Contribution to journalArticle

Hoover, JM, Nwojo, M, Puffer, R, Mandrekar, J, Meyer, FB & Parney, IF 2013, 'Surgical outcomes in recurrent glioma', Journal of Neurosurgery, vol. 118, no. 6, pp. 1224-1231. https://doi.org/10.3171/2013.2.JNS121731
Hoover, Jason M. ; Nwojo, Macaulay ; Puffer, Ross ; Mandrekar, Jayawant ; Meyer, Fredric B. ; Parney, Ian F. / Surgical outcomes in recurrent glioma. In: Journal of Neurosurgery. 2013 ; Vol. 118, No. 6. pp. 1224-1231.
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abstract = "Object. The object of this study was to assess outcomes after surgery for recurrent intracranial glioma. Methods. The authors retrospectively reviewed cases involving adult patients with intracranial glioma patients undergoing initial surgery (biopsy or resection) and one or more additional surgeries at their institution. Results. A total of 323 operations were performed in 131 patients. The median survival was 76 months after first surgery, 36 months after second, 24 months after third, and 26.5 months after 4 or more surgeries. The overall complication rate was 12.8{\%} after first surgery, 27.0{\%} after second (OR 2.52, p = 0.0068), 22.0{\%} after third (OR 1.92, not statistically significant [NS]), and 22.2{\%} after 4 or more (OR 1.95, NS). Neurological complications occurred in 4.8{\%} of patients at first surgery, 12.1{\%} at second (OR 2.7, p = 0.0437), 8.2{\%} at third (OR 1.75, NS), and 11.1{\%} at 4 or more surgeries (OR 2.4583, NS). Regional complications occurred in 6.2{\%} after first surgery, 9.9{\%} after second surgery (OR 2.30, p = 0.095), 13.7{\%} after third surgery (OR 3.31, p = 0.015), and 22.2{\%} after 4 or more surgeries (OR 5.95, p = 0.056). Systemic complications occurred in 3.2{\%} after first surgery, in 7.3{\%} after second surgery (OR 2.3, p = 0.NS), in 4.1{\%} after third surgery (OR 1.3, NS), and 0{\%} after 4 or more surgeries. Reduction in Karnofsky Performance Status score occurred in 0{\%} after first surgery, 8.1{\%} after second surgery (OR 3.13, p = 0.0018), 10.2{\%} after third surgery (OR 5.52, p < 0.0001), and 11.1{\%} after 4 or more surgeries (OR 1.037, NS). Conclusions. Postoperative survival is relatively prolonged but complication risk increases in patients with glioma who undergo multiple cranial surgeries. The largest increase in neurological risk occurs between the first and second surgery. In contrast, regional complication risk increases consistently with each surgery. The risk of systemic complications is not significantly altered with increasing surgeries. However, these complications only result in a modestly increased risk of functional decline after 2 or more surgeries. These findings may help counsel patients considering multiple glioma surgeries.",
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AU - Hoover, Jason M.

AU - Nwojo, Macaulay

AU - Puffer, Ross

AU - Mandrekar, Jayawant

AU - Meyer, Fredric B.

AU - Parney, Ian F

PY - 2013/6

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N2 - Object. The object of this study was to assess outcomes after surgery for recurrent intracranial glioma. Methods. The authors retrospectively reviewed cases involving adult patients with intracranial glioma patients undergoing initial surgery (biopsy or resection) and one or more additional surgeries at their institution. Results. A total of 323 operations were performed in 131 patients. The median survival was 76 months after first surgery, 36 months after second, 24 months after third, and 26.5 months after 4 or more surgeries. The overall complication rate was 12.8% after first surgery, 27.0% after second (OR 2.52, p = 0.0068), 22.0% after third (OR 1.92, not statistically significant [NS]), and 22.2% after 4 or more (OR 1.95, NS). Neurological complications occurred in 4.8% of patients at first surgery, 12.1% at second (OR 2.7, p = 0.0437), 8.2% at third (OR 1.75, NS), and 11.1% at 4 or more surgeries (OR 2.4583, NS). Regional complications occurred in 6.2% after first surgery, 9.9% after second surgery (OR 2.30, p = 0.095), 13.7% after third surgery (OR 3.31, p = 0.015), and 22.2% after 4 or more surgeries (OR 5.95, p = 0.056). Systemic complications occurred in 3.2% after first surgery, in 7.3% after second surgery (OR 2.3, p = 0.NS), in 4.1% after third surgery (OR 1.3, NS), and 0% after 4 or more surgeries. Reduction in Karnofsky Performance Status score occurred in 0% after first surgery, 8.1% after second surgery (OR 3.13, p = 0.0018), 10.2% after third surgery (OR 5.52, p < 0.0001), and 11.1% after 4 or more surgeries (OR 1.037, NS). Conclusions. Postoperative survival is relatively prolonged but complication risk increases in patients with glioma who undergo multiple cranial surgeries. The largest increase in neurological risk occurs between the first and second surgery. In contrast, regional complication risk increases consistently with each surgery. The risk of systemic complications is not significantly altered with increasing surgeries. However, these complications only result in a modestly increased risk of functional decline after 2 or more surgeries. These findings may help counsel patients considering multiple glioma surgeries.

AB - Object. The object of this study was to assess outcomes after surgery for recurrent intracranial glioma. Methods. The authors retrospectively reviewed cases involving adult patients with intracranial glioma patients undergoing initial surgery (biopsy or resection) and one or more additional surgeries at their institution. Results. A total of 323 operations were performed in 131 patients. The median survival was 76 months after first surgery, 36 months after second, 24 months after third, and 26.5 months after 4 or more surgeries. The overall complication rate was 12.8% after first surgery, 27.0% after second (OR 2.52, p = 0.0068), 22.0% after third (OR 1.92, not statistically significant [NS]), and 22.2% after 4 or more (OR 1.95, NS). Neurological complications occurred in 4.8% of patients at first surgery, 12.1% at second (OR 2.7, p = 0.0437), 8.2% at third (OR 1.75, NS), and 11.1% at 4 or more surgeries (OR 2.4583, NS). Regional complications occurred in 6.2% after first surgery, 9.9% after second surgery (OR 2.30, p = 0.095), 13.7% after third surgery (OR 3.31, p = 0.015), and 22.2% after 4 or more surgeries (OR 5.95, p = 0.056). Systemic complications occurred in 3.2% after first surgery, in 7.3% after second surgery (OR 2.3, p = 0.NS), in 4.1% after third surgery (OR 1.3, NS), and 0% after 4 or more surgeries. Reduction in Karnofsky Performance Status score occurred in 0% after first surgery, 8.1% after second surgery (OR 3.13, p = 0.0018), 10.2% after third surgery (OR 5.52, p < 0.0001), and 11.1% after 4 or more surgeries (OR 1.037, NS). Conclusions. Postoperative survival is relatively prolonged but complication risk increases in patients with glioma who undergo multiple cranial surgeries. The largest increase in neurological risk occurs between the first and second surgery. In contrast, regional complication risk increases consistently with each surgery. The risk of systemic complications is not significantly altered with increasing surgeries. However, these complications only result in a modestly increased risk of functional decline after 2 or more surgeries. These findings may help counsel patients considering multiple glioma surgeries.

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KW - Craniotomy

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KW - Oncology

KW - Outcome

KW - Recurrent

KW - Resection

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