Salvati Maurizio, Pesce Alessandro, Palmieri Mauro, Floriana Brunetto Giacoma Maria, Santoro Antonio, Frati Alessandro
Department of Neurosurgery, Neuromed, IRCCS, Sapienza University of Rome, Pozzilli, Italy.
Azienda Ospedaliera Sant'Andrea, Rome, Italy; Division of Neurosurgery, Department of Neuroscience, Mental Health, and Sense Organs Sapienza University of Rome, Rome, Italy.
World Neurosurg. 2019 Apr;124:e480-e488. doi: 10.1016/j.wneu.2018.12.118. Epub 2019 Jan 3.
The benefits of multiple interventions on the recurrence of high-grade gliomas are renowned. However, the real effect of repeated operations on the survival parameters does not seem to have been assessed. The aim of the present study was to determine whether reoperation for selected patients is safe and feasible.
A total of 78 patients with high-grade glioma had undergone surgery from 2004 to 2014. All the patients had met the following inclusion criteria: American Society of Anesthesiologists score 1-3, Karnofsky performance scale score >60, and reintervention ≥4 months after the first surgery. The following parameters were evaluated: overall survival (OS) after diagnosis and reintervention, progression-free survival (PFS) after reintervention, number of surgical procedures, and OS of patients who had undergone surgery >2 times. The results were compared with those of 78 patients with high-grade glioma who had undergone adjuvant chemotherapy.
OS at 1 year was 100%. At 2 years, OS was 39.4% for those with glioblastoma and 58.3% for those with anaplastic astrocytoma. PFS after 6 months was 53.03% for glioblastoma and 75.0% for anaplastic astrocytoma. Of the 78 patients, 55 had undergone reoperation, with 15 requiring a third intervention and 8 requiring 4. Major complications developed in only 2 patients. Statistical analysis revealed no significant differences in complications or worsening neurological status.
These data showed excellent outcomes in terms of OS and PFS and clinical conditions after multiple surgical procedures. Therefore, reintervention appears to be a feasible and safe solution for selected patients.
多种干预措施对高级别胶质瘤复发的益处已广为人知。然而，重复手术对生存参数的实际影响似乎尚未得到评估。本研究的目的是确定对选定患者进行再次手术是否安全可行。
2004年至2014年期间，共有78例高级别胶质瘤患者接受了手术。所有患者均符合以下纳入标准：美国麻醉医师协会评分1 - 3分，卡诺夫斯基功能状态评分>60分，且首次手术后再次干预时间≥4个月。评估了以下参数：诊断和再次干预后的总生存期（OS）、再次干预后的无进展生存期（PFS）、手术次数以及接受手术>2次的患者的总生存期。将结果与78例接受辅助化疗的高级别胶质瘤患者的结果进行比较。
1年时的总生存率为100%。2年时，胶质母细胞瘤患者的总生存率为39.4%，间变性星形细胞瘤患者为58.3%。胶质母细胞瘤6个月后的无进展生存率为53.03%，间变性星形细胞瘤为75.0%。78例患者中，55例接受了再次手术，其中15例需要第三次干预，8例需要第四次干预。仅2例患者出现了严重并发症。统计分析显示，并发症或神经功能状态恶化方面无显著差异。
这些数据显示，多次手术后在总生存期、无进展生存期和临床状况方面都有良好的结果。因此，再次干预对于选定患者似乎是一种可行且安全的解决方案。
