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CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(01): 1-7
DOI: 10.4103/ajns.AJNS_180_20
Research Article

The impact of surgery on the survival of patients with recurrent glioblastoma

Oumar Sacko   *
1   Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse
2   Université Paul-Sabatier, Toulouse, France
,
Alexandra Benouaich-Amiel   *
1   Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse
2   Université Paul-Sabatier, Toulouse, France
,
Pierre Brandicourt
1   Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse
2   Université Paul-Sabatier, Toulouse, France
,
Mahamadou Niaré
1   Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse
2   Université Paul-Sabatier, Toulouse, France
3   CNRS (Centre Recherche et Cognition), Toulouse
,
Saloua Charni
1   Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse
2   Université Paul-Sabatier, Toulouse, France
3   CNRS (Centre Recherche et Cognition), Toulouse
,
Clarissa Cavandoli
1   Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse
2   Université Paul-Sabatier, Toulouse, France
,
David Brauge
1   Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse
2   Université Paul-Sabatier, Toulouse, France
,
Isabelle Catalaa
4   Neuroradiologie, Centre Hospitalo-Universitaire de Toulouse
2   Université Paul-Sabatier, Toulouse, France
,
Adam Brenner
5   Western University of Health Sciences, Pomona
,
Elizabeth Moyal
2   Université Paul-Sabatier, Toulouse, France
6   Harrison Medical Center, Bremerton, WA, USA
,
Franck-Emmanuel Roux
1   Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse
2   Université Paul-Sabatier, Toulouse, France
3   CNRS (Centre Recherche et Cognition), Toulouse
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Objective: The purpose of this study was to investigate the possible benefit of repeat surgery on overall survival for patients with recurrent glioblastoma multiforme (GBM). Methods: We performed a retrospective analysis of data from patients who presented with recurrent GBM over a 5-year period (n = 157), comparing baseline characteristics and survival for patients who had at least 1 new tumor resection followed by chemotherapy (reoperation group, n = 59) and those who received medical treatment only (no-reoperation group, n = 98) for recurrence. Results: The baseline characteristics of the two groups differed in terms of WHO performance status (better in the reoperation group), mean age (60 years in the reoperation group vs. 65 years in the no-reoperation group), mean interval to recurrence (3 months later in the reoperation group than in the no-reoperation group) and more gross total resections in the reoperation group. Nevertheless, the patients in the reoperation group had a higher rate [32.8%] of sensorimotor deficits than those of the no-reoperation group [14.2]. There was no significant difference in sex; tumor localization, side, or extent; MGMT status; MIB-1 labeling index; or Karnofsky Performance Status [KPS] score. After adjustment for age, the WHO performance status, interval of recurrence, and extent of resection at the first operation, multivariate analysis showed that median survival was significantly better in the reoperation group than in the no-reoperation group (22.9 vs. 14.61 months, P < 0.05). After a total of 69 repeat operations in 59 patients (10 had 2 repeat surgeries), we noted 13 temporary and 20 permanent adverse postoperative events, yielding a permanent complication rate of 28.99% (20/69). There was also a statistically significant (P = 0.029, Student's t-test) decrease in the mean KPS score after reoperation (mean preoperative KPS score of 89.34 vs. mean postoperative score of 84.91). Conclusion: Our retrospective study suggests that repeat surgery may be beneficial for patients with GBM recurrence who have good functional status (WHO performance status 0 and 1), although the potential benefits must be weighed against the risk of permanent complications, which occurred in almost 30% of the patients who underwent repeat resection in this series.

Key-words:

Extent of resection - glioblastoma - neuro-oncology - recurrence - redo surgery - reoperation

Financial support and sponsorship

This work was supported by the CNRS (Centre National pour la Recherche Scientifique) and by the NGO named ARTC (Association pour la Recherche sur les Tumeurs Cerebrales).


* Drs. Sacko and Benouaich-Amiel contributed equally to this work




Publication History

Received: 27 April 2020

Accepted: 16 September 2020

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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