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

Global Spine Journal, 2023 · DOI: 10.1177/21925682221094766 · Published: January 1, 2023

Simple Explanation

This study investigates whether completely removing intramedullary astrocytomas (tumors within the spinal cord) improves patient outcomes compared to only partially removing them. Researchers analyzed data from multiple studies, focusing on overall survival and neurological function after surgery. The goal was to determine if complete resection leads to better survival rates and neurological outcomes without causing further harm.

Study Duration

Not specified

Participants

1079 patients (35 studies); Integrative analysis: 228 patients (13 articles)

Evidence Level

Systematic Review with Individual Patient Data Meta-Analysis

Key Findings

1
Complete resection (CR) significantly improved overall survival (OS) compared to incomplete resection (IR).
2
Multivariate analysis identified extent of resection, pathology grade, and adjuvant therapy as significant prognostic factors for OS.
3
There was no significant difference in post-operative neurologic improvement (PNI) and follow-up neurologic improvement (FNI) between CR and IR groups.

Research Summary

This systematic review and meta-analysis aimed to compare the overall survival (OS) and neurologic outcomes of complete versus incomplete surgical resection for patients with intramedullary astrocytoma. The study included 1079 patients from 35 studies, with individual patient data of 228 patients from 13 articles incorporated into an integrative analysis. The conclusion was that complete resection can improve overall survival compared to incomplete resection, without negatively impacting post-operative neurological status, and adjuvant therapy significantly affects OS, PNI, and FNI.

Practical Implications

Surgical Strategy

Complete resection should be the primary goal of surgery for intramedullary astrocytomas when feasible.

Adjuvant Therapy

Adjuvant therapy should be considered as a routine treatment strategy for spinal cord astrocytoma due to its significant impact on OS, PNI, and FNI.

Intraoperative Decision-Making

Surgeons should rely on intraoperative decisions to prevent neurologic adverse events while aiming for complete resection.

Study Limitations

1
Retrospective and non-randomized nature of included studies.
2
Potential heterogeneity due to different treatment plans and surgeon experiences.
3
Heterogeneity among definitions restricted the ability to make the most of the available data.

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