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Complete Versus Incomplete Surgical Resection in Intramedullary Astrocytoma: Systematic Review With Individual Patient Data Meta-Analysis Publisher



Golpayegani M1 ; Edalatfar M1 ; Ahmadi A2 ; Sadeghinaini M1, 3 ; Salari F4 ; Hanaei S5, 6 ; Shokraneh F7 ; Ghodsi Z1 ; Vaccaro AR8 ; Rahimimovaghar V1, 6, 9, 10, 11, 12
Authors
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Authors Affiliations
  1. 1. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Neurosurgery, Lorestan University of Medical Sciences, Khoram-Abad, Iran
  4. 4. Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Neurosurgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
  6. 6. Universal Scientific Education and Research Network (USERN), Tehran, Iran
  7. 7. Cochrane Schizophrenia Group, The Institute of Mental Health, Nottingham, United Kingdom
  8. 8. Department of Orthopedics and Neurosurgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, PA, United States
  9. 9. Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
  10. 10. Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  11. 11. Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
  12. 12. Spine Program, University of Toronto, Toronto, ON, Canada

Source: Global Spine Journal Published:2023


Abstract

Study Design: Systematic review Background: Considering the infiltrative nature of intramedullary astrocytoma, the goal of surgery is to have a better patient related outcome. Objective: To compare the overall survival (OS) and neurologic outcomes of complete vs incomplete surgical resection for patients with intramedullary astrocytoma. Methods: A comprehensive search of MEDLINE, CENTRAL and EMBASE was conducted by two independent reviewers. Individual patient data (IPD) analysis and multivariate Cox Proportional Hazard Model was developed to measure the effect of surgical strategies on OS, post-operative neurological improvement (PNI), and neurological improvement in the last follow up (FNI). Results: We included 1079 patients from 35 studies. Individual patient data of 228 patients (13 articles) was incorporated into the integrative IPD analysis. Kaplan-Meier survival analysis showed complete resection (CR) significantly improved OS in comparison with the incomplete resection (IR) (log-rank test, P =.004). In the multivariate IPD analysis, three prognostic factors had significant effect on the OS: (1) Extent of Resection, (2) pathology grade, and (3) adjuvant therapy. We observed an upward trend in the popularity of chemotherapy, but CR, IR, and radiotherapy had relatively stable trends during three decades. Conclusion: Our study shows that CR can improve OS when compared to IR. Patients with spinal cord astrocytoma undergoing CR had similar PNI and FNI compared to IR. Therefore, CR should be the primary goal of surgery, but intraoperative decisions on the extent of resection should be relied on to prevent neurologic adverse events. Due to significant effect of adjuvant therapy on OS, PNI and FNI, it could be considered as the routine treatment strategy for spinal cord astrocytoma. © The Author(s) 2022.
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