Pascual Juan Silvestre G, Duffau Hugues
Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Avenue Agustin Fliche, 34295, Montpellier, France.
Acta Neurochir (Wien). 2022 Oct;164(10):2789-2809. doi: 10.1007/s00701-022-05339-y. Epub 2022 Aug 9.
For a long time, return to work (RTW) has been neglected in patients harboring a diffuse low-grade glioma (LGG). However, a majority of LGG patients worked at time of diagnosis. Moreover, these patients now live longer given current treatment paradigms, especially thanks to early maximal surgery.
We systematically searched available medical databases for studies that reported data on RTW in patients who underwent resection for LGG.
A total of 30 studies were selected: 19 considered RTW (especially rate and timing) as an outcome and 11 used scales of health-related quality of life (HRQoL) which included work-related aspects. Series that considered RTW as a main endpoint were composed of 1014 patients, with postoperative RTW rates ranging from 31 to 97.1% (mean 73.1%). Timing to RTW ranged from 15 days to 22 months (mean 6.3 months). Factors related to an increased proportion of RTW were: younger age, better neurologic status, having a white-collar occupation, working pre-operatively, being the sole breadwinner, the use of awake surgery, and greater extent of resection. Female sex, older age, poor neurologic status, pre-operative history of work absences, slow lexical access speed, and postoperative seizures were negatively related to RTW. No studies that used HRQoL scales directly investigated RTW rate or timing.
RTW was scarcely analyzed in LGG patients who underwent resection. However, because they are usually young, with no or only mild functional deficits and have a longer life expectancy, postoperative RTW should be assessed more systematically and accurately as a main outcome. As majority (61.5-100%) of LGG patients were working at time of surgery, the responsibility of neurosurgeons is to bring these patients back to their previous activities according to his/her wishes. RTW might also be included as a critical endpoint for future prospective studies and randomized control trials on LGGs.
长期以来，弥漫性低级别胶质瘤（LGG）患者的重返工作岗位（RTW）问题一直被忽视。然而，大多数LGG患者在确诊时仍在工作。此外，鉴于目前的治疗模式，尤其是早期最大程度手术，这些患者现在的生存期更长。
我们系统检索了可用的医学数据库，以查找报告LGG切除术后患者RTW数据的研究。
共筛选出30项研究：19项将RTW（尤其是比率和时间）作为结局指标，11项使用了包括与工作相关方面在内 的健康相关生活质量（HRQoL）量表。将RTW作为主要终点的系列研究共纳入1014例患者，术后RTW率在31%至97.1%之间（平均73.1%）。RTW的时间范围为15天至22个月（平均6.3个月）。与RTW比例增加相关的因素包括：年龄较小、神经功能状态较好、从事白领职业、术前工作、是家庭唯一经济支柱、采用清醒手术以及切除范围更大。女性、年龄较大、神经功能状态较差、术前有缺勤史、词汇获取速度较慢以及术后癫痫发作与RTW呈负相关。没有使用HRQoL量表的研究直接调查RTW率或时间。
接受切除手术的LGG患者的RTW很少被分析。然而，由于他们通常较年轻，没有或只有轻度功能缺陷且预期寿命较长，术后RTW应作为主要结局更系统、准确地进行评估。由于大多数（61.5%-100%）LGG患者在手术时仍在工作，神经外科医生的责任是根据患者意愿使其恢复术前活动。RTW也可作为未来LGG前瞻性研究和随机对照试验的关键终点。
