Khan Ursalan A, Bhavsar Amar, Asif Hasan, Karabatsou Konstantina, Leggate James R S, Sofat Ajit, Kamaly-Asl Ian D
Department of Neurosurgery, Greater Manchester Neurosciences Centre, Salford Royal Hospital, Salford; and.
J Neurosurg. 2015 Feb;122(2):297-302. doi: 10.3171/2014.10.JNS132057. Epub 2014 Nov 21.
Surgeries for CNS tumors are frequently performed by general neurosurgeons and by those who specialize in surgical neurooncology. Subspecialization in neurosurgical practice has become common and may improve patient morbidity and mortality rates. However, the potential benefits for patients of having their surgeries performed by surgical neurooncologists remain unclear. Recently, a shift in patient care to those who practice predominantly surgical neurooncology has been promoted. Evidence for this practice is lacking and therefore requires fundamental investigation.
The authors conducted a case-control study of neurooncology patients who underwent surgery for glioblastoma and anaplastic astrocytoma during 2006-2009. Outcomes were compared for patients whose surgery was performed by general neurosurgeons (generalists) or by specialist neurooncology neurosurgeons (specialists). An electronic record database and a picture archiving and communication system were used to collect data and assess the extent of tumor resection. Mortality rates and survival times were compared. Patient comorbidity and postoperative morbidity were assessed by using the Waterlow, patient handling, and falls risk assessment scores. Effects of case mix were adjusted for by using Cox regression and a hazards model.
Outcomes for 135 patients (65 treated by generalists and 70 by specialists) were analyzed. Survival times were longer for patients whose surgery was performed by specialists (p=0.026) and after correction for case mix (p=0.019). Extent of tumor resection was greater when performed by specialists (p=0.005) and correlated with increased survival times (p=0.004). There was a trend toward reduced surgical deaths when surgery was performed by specialists (2.8%) versus generalists (7%) (p=0.102), and inpatient stays were significantly shorter when surgery was performed by specialists (p=0.008).
The prognosis for glioblastoma multiforme remains dire, and improved treatments are urgently needed. This study provides evidence for a survival benefit when surgery is performed by specialist neurooncology neurosurgeons. The benefit might be attributable to increased tumor resection. Furthermore, specialist neurooncology surgical care may reduce the number of surgical patient deaths and length of inpatient stay. These findings support the recommendations for subspecialization within surgical neurooncology and advocate for care of these patients by specialists.
中枢神经系统肿瘤手术通常由普通神经外科医生和神经肿瘤外科专科医生进行。神经外科实践中的亚专业分工已很常见，可能会改善患者的发病率和死亡率。然而，手术由神经肿瘤外科医生进行对患者的潜在益处仍不明确。最近，患者护理已转向主要由神经肿瘤外科医生进行手术的方向。这种做法缺乏证据，因此需要进行基础研究。
作者对2006年至2009年间接受胶质母细胞瘤和间变性星形细胞瘤手术的神经肿瘤患者进行了病例对照研究。比较了由普通神经外科医生（普通医生）或神经肿瘤专科神经外科医生（专科医生）进行手术的患者的结局。使用电子记录数据库和图像存档与通信系统收集数据并评估肿瘤切除范围。比较了死亡率和生存时间。通过使用沃特洛评分、患者处理评分和跌倒风险评估评分来评估患者的合并症和术后发病率。通过使用Cox回归和风险模型对病例组合的影响进行了调整。
分析了135例患者的结局（65例由普通医生治疗，70例由专科医生治疗）。由专科医生进行手术的患者生存时间更长（p = 0.026），在对病例组合进行校正后（p = 0.019）也是如此。由专科医生进行手术时肿瘤切除范围更大（p = 0.005），且与生存时间延长相关（p = 0.004）。由专科医生进行手术时手术死亡有减少的趋势（2.8%），而由普通医生进行手术时为（7%）（p = 0.102），由专科医生进行手术时住院时间明显更短（p = 0.008）。
多形性胶质母细胞瘤的预后仍然很差，迫切需要改进治疗方法。这项研究为神经肿瘤专科神经外科医生进行手术时的生存获益提供了证据。这种获益可能归因于肿瘤切除范围的增加。此外，神经肿瘤专科手术护理可能会减少手术患者的死亡人数和住院时间。这些发现支持了神经肿瘤外科亚专业分工的建议，并主张由专科医生对这些患者进行护理。
