gms | German Medical Science

Objective: Surgical resection of brain metastases is carried out with the aim of prolonging survival or preventing impending neurological deficits. There is an inherent difficulty in deciding to perform brain surgery on an often fragile and comorbid patient. The aim of this analysis, based on prospectively collected data, is to assess the risks of complications, identify their predictors and evaluate their effect on outcome.

Methods: We included consecutive patients who underwent surgical resection of brain metastases at our institution since June 2013 up until 2016 in the present analysis. The definition of postoperative complications included new neurological deficits, hemorrhage, ischemia or the need for wound revision. Systemic Infections requiring therapy were equally included. We employed univariate and multivariate analyses where applicable as well as survival (Kaplan Meier log-rank) to assess predictors and effects of postoperative surgical complications.

Results: A total of 168 patients were included in the present analysis (53.6% male, mean age 63yrs (CI95%: 47-80yrs)). The primary tumor originated from the lung in 81 cases (48%). Complications were recorded in 36 patients (21.4%). Postoperative hemorrhage or ischemia occurred in 11/168 cases (6.5%), while infections (local and systemic) occurred in 22/168 patients (13.1%). New neurological deficits were present after surgery in 8.9% (15/168). Among the analyzed predictive factors, duration of surgery was associated with postoperative infections (p=0.005), but not with hemorrhage or neurological impairment. Kaplan-Meier Log rank testing demonstrated a marked difference between patients with (median 6 weeks (CI95%: 0.1-17.9)) and without complications (median 27.0 weeks (CI95%: 22.4-31.6); p<0.001). Patients with new neurological deficits had a median survival of 2 weeks (CI95%: 0.1-4.2) vs. 25 weeks without new neurological deficit (25 weeks; (CI95% 21.1-28.9); p<0.001). Patients with postoperative hemorrhage had a median survival of 2 weeks (CI95%: 0.1-4.1) compared to 24 weeks (CI95%: 20.1-27.9; p<0.001) without hemorrhage. Postoperative infections were not associated with lower survival rates (21 weeks (CI95%: 4.6-37.4)) compared to patients without infections (23 weeks (CI95%: 19.7-26.3; p=0.23)).

Conclusion: Based on data from a prospective study on metastastic disease we found that one in five patients undergoing brain surgery suffer from complications which may dramatically reduce survival. We advocate including this data in discussing expected outcomes with patients and their families. While potentially serious, infections did not significantly affect survival in our cohort.