Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy.
J Neurooncol. 2023 Feb;161(3):625-632. doi: 10.1007/s11060-022-04232-z. Epub 2023 Jan 23.
INTRODUCTION: The surgical goal in glioblastoma treatment is the maximal safe resection of the tumor. Currently the lack of consensus on surgical technique opens different approaches. This study describes the "perilesional technique" and its outcomes in terms of the extent of resection, progression free survival and overall survival. METHODS: Patients included (n = 40) received a diagnosis of glioblastoma and underwent surgery using the perilesional dissection technique at "San Gerardo Hospital"between 2018 and 2021. The tumor core was progressively isolated using a circumferential movement, healthy brain margins were protected with Cottonoid patties in a "shingles on the roof" fashion, then the tumorwas removed en bloc. Intraoperative ultrasound (iOUS) was used and at least 1 bioptic sample of "healthy" margin of the resection was collected and analyzed. The extent of resection was quantified. Extent of surgical resection (EOR) and progression free survival (PFS)were safety endpoints of the procedure. RESULTS: Thirty-four patients (85%) received a gross total resection(GTR) while 3 (7.5%) patients received a sub-total resection (STR), and 3 (7.5%) a partial resection (PR). The mean post-operative residual volume was 1.44 cm (range 0-15.9 cm).During surgery, a total of 76 margins were collected: 51 (67.1%) were tumor free, 25 (32.9%) were infiltrated. The median PFS was 13.4 months, 15.3 in the GTR group and 9.6 months in the STR-PR group. CONCLUSIONS: Perilesional resection is an efficient technique which aims to bring the surgeon to a safe environment, carefully reaching the "healthy" brain before removing the tumoren bloc. This technique can achieve excellent tumor margins, extent of resection, and preservation of apatient's functions.
简介:胶质母细胞瘤治疗的手术目标是最大限度地安全切除肿瘤。目前,由于缺乏对手术技术的共识,导致出现了不同的方法。本研究描述了“瘤周技术”及其在切除程度、无进展生存期和总生存期方面的结果。
方法:2018 年至 2021 年期间,在“圣杰尔达医院”接受手术的胶质母细胞瘤患者(n=40)采用瘤周解剖技术。使用环形运动逐步隔离肿瘤核心,用 Cottonoid 垫在“屋顶上的带状疱疹”样式保护健康的脑边缘,然后整块切除肿瘤。术中使用超声(iOUS),至少采集并分析 1 份肿瘤切除“健康”边缘的活检样本。切除程度量化。手术切除范围(EOR)和无进展生存期(PFS)是该手术的安全性终点。
结果:34 例患者(85%)行大体全切除(GTR),3 例(7.5%)行次全切除(STR),3 例(7.5%)行部分切除(PR)。术后残余体积平均为 1.44cm(范围 0-15.9cm)。术中共采集 76 个边缘:51 个(67.1%)无肿瘤,25 个(32.9%)有浸润。中位 PFS 为 13.4 个月,GTR 组为 15.3 个月,STR-PR 组为 9.6 个月。
结论:瘤周切除术是一种有效的技术,旨在为外科医生提供一个安全的环境,在整块切除肿瘤之前仔细到达“健康”的大脑。该技术可以获得良好的肿瘤边界、切除范围和患者功能的保留。
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