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The patients’ view: impact of the extent of resection, intraoperative imaging, and awake surgery on health-related quality of life in high-grade glioma patients—results of a multicenter cross-sectional study

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Abstract

The objective of the present study is to assess the influence of extent of resection (EoR), use of intraoperative imaging, and awake surgery on health-related quality of life (HRQoL) in high-grade glioma (HGG) patients in a prospective multicenter study. We analyzed 170 surgeries of patients suffering from a HGG. During the first year after resection, HRQoL was evaluated using the European Organization of Research and Treatment of Cancer Core Questionnaire C30 and Brain Neoplasm 20 questionnaires. We assessed the influence of EoR; awake surgery; and use of 5-aminolevulinic acid (5-ALA), intraoperative MRI (iMRI), and their combination on sum scores for function and symptoms as well as several neurological single items. In mixed-model analyses, adjustments for age, Karnofsky performance status (KPS), and eloquent location were performed. In the mixed model, EoR generally did not significantly influence HRQoL (p = 0.10). Yet, patients receiving subtotal resection (STR) vs. patients with biopsy showed significantly better QoL and role and cognitive functions (p = 0.04, p = 0.02, and p < 0.01, respectively). The combination of iMRI and 5-ALA reached the highest EoR (95%) followed by iMRI alone (94%), 5-ALA alone (74%), and no imaging (73%). Thereby, neurological symptoms were lowest and functioning score highest after combined use of iMRI and 5-ALA, without reaching significance (p = 0.59). Despite lower scores in emotional function (59 vs. 46, p = 0.24), no significant impact of awake surgery on HRQoL was found (p = 0.70). In HGG patients, STR compared to biopsy was significantly associated with better HRQoL and fewer neurological symptoms in this series. An escalated use of intraoperative imaging increased EoR with stable or slightly better HRQoL and fewer neurological symptoms. Based on HRQoL, awake surgery was a well-tolerated and safe method in our series.

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Acknowledgements

The authors thank Sonja Grüninger, Monika Deininger, Güler Savas, Christa Topp, Heike Lahr, Doro Maurer, Linda Messing, and Larissa Reitzug for their reliable cooperation.

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Authors and Affiliations

  1. Department of Neurosurgery, University Ulm, Günzburg, Germany

    Katrin Nickel, Linda Stöckelmaier, Jens Engelke, Christian Rainer Wirtz & Jan Coburger

  2. Department of Neurosurgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany

    Mirjam Renovanz

  3. Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany

    Jochem König

  4. Center for Endoscopic and Minimally Invasive Neurosurgery, Klinik Hierslanden, Zürich, Switzerland

    Anne-Katrin Hickmann

  5. Department of Neurosurgery, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany

    Minou Nadji-Ohl & Oliver Ganslandt

  6. Department of Neurosurgery, Klinikum Ludwigsburg, Ludwigsburg, Germany

    Elke Weimann & Dirk Freudenstein

  7. Department of Internal Medicine III, University Ulm, Ulm, Germany

    Lars Bullinger

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  1. Katrin Nickel
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Correspondence to Jan Coburger.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Nickel, K., Renovanz, M., König, J. et al. The patients’ view: impact of the extent of resection, intraoperative imaging, and awake surgery on health-related quality of life in high-grade glioma patients—results of a multicenter cross-sectional study. Neurosurg Rev 41, 207–219 (2018). https://doi.org/10.1007/s10143-017-0836-x

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