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Effects of supra-total resection in neurocognitive and oncological outcome of high-grade gliomas comparing asleep and awake surgery

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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.

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Data availability

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

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Acknowledgements

The authors would express their gratitude to the entire nurses teams of the Division of Neurosurgery and Anesthesiology for the daily interest, diligence and support, and the Direction Team of the APSS for their support to the work of the Division of Neurosurgery in the neuro-oncology field.

Funding

The extensive neuropsychological analyses of the NePsi Project (Division of Neurosurgery, “Santa Chiara Hospital”, Trento, Italy) included in this paper were supported by CARITRO Foundation (Trento, Italy) and the Direction Team of the Azienda Provinciale per I Servizi Sanitari of Trento.

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Authors and Affiliations

  1. Department of Neurosurgery, “S. Chiara” Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), 9, Largo Medaglie D’Oro, 38122, Trento, Italy

    Luca Zigiotto, Luciano Annicchiarico, Francesco Corsini & Silvio Sarubbo

  2. Department of Intensive Care I, “S. Chiara” Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy

    Luca Vitali, Roberta Falchi & Chiara Dalpiaz

  3. Department of Radiology, Division of Neuroradiology, “S. Chiara” Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy

    Umberto Rozzanigo

  4. Department of Histopathology, “S. Chiara” Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy

    Mattia Barbareschi

  5. Neuroinformatics Lab (NiLab), Fondazione Bruno Kessler (FBK), Trento, Italy

    Paolo Avesani

  6. Centro Di Riabilitazione Neurocognitiva (CeRiN), CIMeC, University of Trento, Trento, Italy

    Costanza Papagno

  7. Department of Neurosurgery, Hopital Gui de Chauliac, University of Montpellier, Montpellier, France

    Hugues Duffau

  8. Department of Psychology, University of Milano-Bicocca, Milan, Italy

    Luca Zigiotto & Costanza Papagno

  9. Department of Neurosurgery, “Azienda Ospedaliera di Padova”, Padua, Italy

    Franco Chioffi

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  1. Luca Zigiotto
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  2. Luciano Annicchiarico
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  3. Francesco Corsini
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  13. Silvio Sarubbo
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Corresponding author

Correspondence to Silvio Sarubbo.

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The authors declare that they have no conflicts of interest.

Ethical approval

This retrospective study respects the ethical standards of the Declaration of Helsinki (BMJ 1991; 302: 1194).

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11060_2020_3494_MOESM8_ESM.tif

Online Resource Figure 1: Cumulative hazard for patients with post-operative tumor infiltration index < or > 9. Supplementary file8 (TIF 370 kb)

11060_2020_3494_MOESM9_ESM.tif

Online Resource Figure 2: Kaplan-Meier curves for patients with post-operative tumor infiltration index < or > 9. Supplementary file9 (TIF 419 kb)

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Zigiotto, L., Annicchiarico, L., Corsini, F. et al. Effects of supra-total resection in neurocognitive and oncological outcome of high-grade gliomas comparing asleep and awake surgery. J Neurooncol 148, 97–108 (2020). https://doi.org/10.1007/s11060-020-03494-9

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