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Supramaximal resection based on en-bloc technique reduces tumor burden and prolongs survival in primary supratentorial lobar glioblastoma

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Abstract

Purpose

Resection beyond the contrast-enhanced zone contributed to reduce tumor burden and prolong survival in glioblastomas. The optimal extent of resection (EOR) and how to achieve it are worthy of continuous investigation for obtaining a satisfactory balance between maximal resection and the preservation of neurological function.

Methods

A total of 340 adult supratentorial lobar glioblastomas (included astrocytoma, WHO 4, IDH mutation and glioblastoma) were retrospectively evaluated. The clinical data, EOR, technique of resection, postoperative complications, overall survival (OS) and progression-free survival (PFS) were assessed by univariate, multivariate and propensity score matched analysis. Histological staining was performed to comprehend the effect of the membranous structures and the cell distribution in tumoral and peritumoral regions.

Results

Supramaximal resection (SMR) was confirmed as resection with 100% EORCE and > 50% EORnCE in glioblastomas by Cox proportional hazards model. Histological results showed SMR reduced the cell density of surgical edge compared to total resection. En-bloc technique based on membranous structures, which had blocking effect on tumoral invasion, contributed to achieve SMR. Moreover, applying en-bloc technique and achieving SMR did not additionally deteriorate neurological function and had similarly effects on the improvement of neurological function. Multivariate analysis confirmed that IDH1 status, technique of resection and EOR were independently correlated with PFS, and > 64 years old, IDH1 status, technique of resection, EOR and preoperative NIHSS were independently correlated with OS.

Conclusions

Applying en-bloc technique and achieving SMR, which could reduce tumor burden and did not increase additional complications, both had remarkedly positive effects on clinical outcomes in patients with primary supratentorial lobar glioblastomas.

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Data availability

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

None.

Funding

National Natural Science Foundation of China (Grant Number: 81702473, 82102100), Natural Science Foundation of Guangdong Province (Grant Number: 2114050002642), President Fund of Nanfang Hospital (Grant Number: 2018Z015), and Clinical Research Program of Nanfang Hospital (Grant/Award Number: 2020CR017). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China

    Tianshi Que, Guanglong Huang, Peidong Zhang, Zhiyong Li, Guozhong Yi, Haojie Zheng, Xi Yuan, Junlu Liu, Haiyan Xu, Xi-an Zhang & Songtao Qi

  2. Nanfang Glioma Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China

    Tianshi Que, Guanglong Huang, Peidong Zhang, Zhiyong Li, Guozhong Yi, Haojie Zheng, Xi Yuan, Junlu Liu, Haiyan Xu, Xi-an Zhang & Songtao Qi

  3. Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China

    Jian-er Tan

  4. Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China

    Peidong Zhang

  5. Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China

    Xiang Xiao

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  1. Tianshi Que
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by TQ, JT, PZ, ZL, HZ, GY, XX, HX and JL. The first draft of the manuscript was written by TQ and GH, and was revised by SQ and XZ. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Xi-an Zhang or Songtao Qi.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committees of Nanfang Hospital (No. 2013-105).

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the images in Figs. 1A, B, 2F and Supplementary Figs. 1A.

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Que, T., Huang, G., Tan, Je. et al. Supramaximal resection based on en-bloc technique reduces tumor burden and prolongs survival in primary supratentorial lobar glioblastoma. J Neurooncol 164, 557–568 (2023). https://doi.org/10.1007/s11060-023-04399-z

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