Luca Zigiotto1,2, Luciano Annicchiarico1, Francesco Corsini1, Luca Vitali3, Roberta Falchi3, Chiara Dalpiaz3, Umberto Rozzanigo4, Mattia Barbareschi5, Paolo Avesani6, Costanza Papagno7,2, Hugues Duffau8, Franco Chioffi9, Silvio Sarubbo10. 1. Department of Neurosurgery, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), 9, Largo Medaglie D'Oro, 38122, Trento, Italy. 2. Department of Psychology, University of Milano-Bicocca, Milan, Italy. 3. Department of Intensive Care I, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy. 4. Department of Radiology, Division of Neuroradiology, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy. 5. Department of Histopathology, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy. 6. Neuroinformatics Lab (NiLab), Fondazione Bruno Kessler (FBK), Trento, Italy. 7. Centro Di Riabilitazione Neurocognitiva (CeRiN), CIMeC, University of Trento, Trento, Italy. 8. Department of Neurosurgery, Hopital Gui de Chauliac, University of Montpellier, Montpellier, France. 9. Department of Neurosurgery, "Azienda Ospedaliera di Padova", Padua, Italy. 10. Department of Neurosurgery, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), 9, Largo Medaglie D'Oro, 38122, Trento, Italy. silviosarubbo@gmail.com.
Abstract
PURPOSE: Awake surgery is an established technique for resection of low-grade gliomas, while its possible benefit for resection of high-grade gliomas (HGGs) needs further confirmations. This retrospective study aims to compare overall survival, extent of resection (EOR) and cognitive outcome in two groups of HGGs patients submitted to asleep or awake surgery. METHODS: Thirty-three patients submitted to Gross Total Resection of contrast-enhancing area of HGGs were divided in two homogeneous groups: awake (AWg; N = 16) and asleep surgery (ASg; N = 17). All patients underwent to an extensive neuropsychological assessment before surgery (time_1), 1-week (time_2) and 4-months (time_3) after surgery. We performed analyses to assess differences in cognitive performances between groups, cognitive outcomes in each group and EOR. A comparison of overall survival (OS) between the two groups was conducted. RESULTS: Statistical analyses showed no differences between groups at time_2 and time_3 in each cognitive domain, excluding selective attention that resulted higher in the AWg before surgery. Regarding cognitive outcomes, we found a reversible worsening of memory and constructional praxis, and a significant recovery at time_3, similar for both groups. Assessment of time_3 in respect to time_1 never showed differences (all ps > .074). Moreover we found a significant lower level of tumor infiltration after surgery for AWg (p < .05), with an influence on OS (p < .05). Indeed, patients of AWg showed a significant longer OS in comparison to those in the ASg (p < .01). This result was confirmed even considering only wildtype Glioblastoma (p < .05). CONCLUSION: These results indicate that awake surgery, and in general a supra-total resection of enhancing area, can improve OS in HGGs patients, preserving neuro-cognitive profile and quality of life.
PURPOSE: Awake surgery is an established technique for resection of low-grade gliomas, while its possible benefit for resection of high-grade gliomas (HGGs) needs further confirmations. This retrospective study aims to compare overall survival, extent of resection (EOR) and cognitive outcome in two groups of HGGs patients submitted to asleep or awake surgery. METHODS: Thirty-three patients submitted to Gross Total Resection of contrast-enhancing area of HGGs were divided in two homogeneous groups: awake (AWg; N = 16) and asleep surgery (ASg; N = 17). All patients underwent to an extensive neuropsychological assessment before surgery (time_1), 1-week (time_2) and 4-months (time_3) after surgery. We performed analyses to assess differences in cognitive performances between groups, cognitive outcomes in each group and EOR. A comparison of overall survival (OS) between the two groups was conducted. RESULTS: Statistical analyses showed no differences between groups at time_2 and time_3 in each cognitive domain, excluding selective attention that resulted higher in the AWg before surgery. Regarding cognitive outcomes, we found a reversible worsening of memory and constructional praxis, and a significant recovery at time_3, similar for both groups. Assessment of time_3 in respect to time_1 never showed differences (all ps > .074). Moreover we found a significant lower level of tumor infiltration after surgery for AWg (p < .05), with an influence on OS (p < .05). Indeed, patients of AWg showed a significant longer OS in comparison to those in the ASg (p < .01). This result was confirmed even considering only wildtype Glioblastoma (p < .05). CONCLUSION: These results indicate that awake surgery, and in general a supra-total resection of enhancing area, can improve OS in HGGs patients, preserving neuro-cognitive profile and quality of life.
Authors: Diana Cristina Ghinda; Ben Lambert; Junfeng Lu; Ning Jiang; Eve Tsai; Adam Sachs; Jin-Song Wu; Georg Northoff Journal: Front Oncol Date: 2021-02-23 Impact factor: 6.244