Article
Do extent of resection and methods of surgery have an impact on quality of life? A prospective multicenter analysis of 139 high-grade glioma patients in outpatient setting
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Authors
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Katrin Nickel
- Klinik für Neurochirurgie, Universität Ulm, Standort Günzburg, Günzburg, Germany
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Mirjam Renovanz
- Klinik für Neurochirurgie, Universitätsmedizin Mainz, Mainz, Germany
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Minou Nadji-Ohl
- Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart, Germany
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Alf Giese
- Klinik für Neurochirurgie, Universitätsmedizin Mainz, Mainz, Germany
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Christian Rainer Wirtz
- Klinik für Neurochirurgie, Universität Ulm, Standort Günzburg, Günzburg, Germany
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Jan Coburger
- Klinik für Neurochirurgie, Universität Ulm, Standort Günzburg, Günzburg, Germany
| Published: | June 8, 2016 |
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Outline
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Objective: In this prospective study we aimed to assess impact of extent of resection (EoR) and use of intraoperative imaging or awake surgery on quality of life (QoL) in high-grade glioma (HGG) patients.
Method: As part of a prospective multicenter study we assessed QoL in 265 glioma patients from 2013 to 2015 using EORTC QLQ-C30+BN20 questionnaire. We analyzed influence of EoR, use of intraoperative MRI (iMRI), 5-Aminolevulinic acid (5-ALA) and awake surgery on QoL in the subgroup of HGG patients. Differences in distribution, mean value of single items and subscores of questionnaire were calculated and tested for significance using t-test or ANOVA.
Results: 104 patients were included in total. M:f ratio was 1.5:1.0 and the mean age was 57 years. The relationship between WHO° IV and III was 3:1. Majority of lesions were found frontal (39%), temporal (36%) and parietal (16%). EoR was distributed as follows: GTR n=53 (51%), failed GTR n=9 (9%), STR n=30 (29%), biopsy n=9 (9%). There were 11 (12%) awake surgeries in general. Overall there were no significant differences in subscores concerning EoR. Interestingly, the single item of ‘QoL’ and ‘global health’ was significantly reduced in successful GTR in comparison to ‘failed’ GTR. A planned STR showed worst QoL. In those cases in which GTR was primarily intended (GTR&failed GTR), we compared following surgical groups being ‘no imaging’(n=24), iMRI(n=10) vs. iMRT&5-ALA(n=17) vs. 5-ALA(n=11). There was no significant difference in global QoL based on the use of intraoperative imaging or not. Functional scores were similar either. However, a significant better seizure control was found using iMRI (p<0.02). After awake surgery, role and social function and also global health perception were reduced in comparison to patients with general anesthesia.
Conclusions: Patients suffering from a lesion not amenable for a GTR show a lower postoperative QoL. Interestingly patients with a ‘failed’ GTR seem to have a higher QoL than patients after radical GTR. This implies again a maximum safe resection approach. In general, postoperative QoL does not depend on type of intraoperative imaging. Yet, use of iMRI leads to a significant better seizure control in HGG patients. The reduced role and social function in awake surgery patients could be interpreted as a sign of posttraumatic stress disorder. Further data are needed in this regard.
