Department of Neurosurgery, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania.
Department of Neurosurgery, Cluj County Clinical Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania.
Adv Tech Stand Neurosurg. 2024;49:181-200. doi: 10.1007/978-3-031-42398-7_9.
The role of surgery in the management of malignant gliomas has been feverishly deliberated after the publication of the first expansive case series, the last two decades reinvigorating the discussion regarding the value of total removal in improving survivability. Despite numerous technologies being implemented to increase the resection rates of malignant gliomas, the role of surgical experience has been largely overlooked. This article aims to discuss the importance of a single surgeon's experience in treating high-grade gliomas over a period of 20 years.
In order to demonstrate the role of surgical experience, we divided the patients operated by a single neurosurgeon into two distinct intervals: between 2000 and 2009 and between 2012 and 2020, respectively. Only cases with subsequent adjuvant radio-chemotherapy were included. For objective reasons, no technologies that could assist the extent of resection (EOR) such as intraoperative MRI (iMRI) or 5-ALA could be used in the country of our study. Gross total resection was the main goal whenever possible, whereas subtotal removal was defined as a clear remnant on contrasted MRI or CT performed 24-48 h postoperatively. Using the Kaplan-Meier method, we analyzed the survival and disease-free interval of our patients according to age, pathology, and degree of resection.
In the 20-year interval of our retrospective study, the main author (ISF) operated 1591 cases of gliomas in a total of 1878 surgeries, including recurrences. The number of high-grade glioma (HGG) patients was 909 (57.10%), 495 of which were male (54.5%) and 414 (45.5%) female. The mean age of the HGG population was 51.9 years. The most common type of HGG subtype were glioblastomas with a total number 620 cases (68.2%). Regarding overall survival (OS), average survival at 12 months was better by 1.6%, and 12.1% improved at 18 months and 17.8% longer at 24 months in the 2012-2020 interval. The mean OS in the earlier interval was 11.00 months compared to the second when it reached 13.441 months (CI, 12.642-14.24).
Surgical treatment represents a critical step in the multimodal treatment of malignant gliomas. According to our results, surgical experience improves not only overall survival in a manner equivalent to adjuvant chemotherapy but also the quality of life. As such, a special qualification in neurooncology may prove necessary in offering these patients a second chance at life.
首例广泛病例系列报告发表后，外科手术在恶性神经胶质瘤治疗中的作用备受热议，最近二十年来，全切除在提高生存率方面的价值再次引发讨论。尽管为提高恶性神经胶质瘤切除率实施了多项技术，但外科医生经验的作用在很大程度上被忽视了。本文旨在讨论一位外科医生在 20 年期间治疗高级别神经胶质瘤的经验的重要性。
为了说明外科医生经验的重要性，我们将由一位神经外科医生手术的患者分为两个不同的时间段：2000 年至 2009 年和 2012 年至 2020 年。仅纳入随后接受辅助放化疗的病例。由于客观原因，在我们研究的国家，无法使用术中磁共振成像（iMRI）或 5-ALA 等可辅助切除范围（EOR）的技术。只要有可能，就以实现大体全切除为主要目标，而次全切除定义为术后 24-48 小时行对比增强磁共振成像或 CT 检查时可见明确残留。使用 Kaplan-Meier 法，我们根据年龄、病理和切除程度分析了患者的生存和无病间隔。
在我们回顾性研究的 20 年期间，主要作者（ISF）共进行了 1878 例神经胶质瘤手术，其中包括复发病例，共 1591 例。高级别神经胶质瘤（HGG）患者为 909 例（57.10%），其中男性 495 例（54.5%），女性 414 例（45.5%）。HGG 患者的平均年龄为 51.9 岁。最常见的 HGG 亚型为胶质母细胞瘤，共 620 例（68.2%）。关于总生存（OS），2012-2020 期间 12 个月时的平均生存时间提高了 1.6%，18 个月时提高了 12.1%，24 个月时提高了 17.8%。早期间隔的平均 OS 为 11.00 个月，而第二个间隔时达到 13.441 个月（CI，12.642-14.24）。
外科治疗是恶性神经胶质瘤多模式治疗的关键步骤。根据我们的结果，外科医生经验不仅可以提高辅助化疗等效的总体生存率，还可以提高生活质量。因此，为这些患者提供第二次生命的机会，可能需要神经肿瘤学方面的特殊资质。
