1. Surgeon experience in glioblastoma surgery of the elderly-a multicenter, retrospective cohort study.
- Author
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Pöppe JP, Machegger L, Steinbacher J, Stefanits H, Eisschiel S, Gruber A, Demetz M, Ladisich B, Kraus TFJ, Weis S, Spiegl-Kreinecker S, Romagna A, Griessenauer CJ, Jahromi BR, Rautalin I, Niemelä M, Korja M, and Schwartz C
- Subjects
- Aged, Humans, Retrospective Studies, Neurosurgical Procedures methods, Neurosurgeons, Hospitals, Teaching, Glioblastoma pathology, Brain Neoplasms pathology
- Abstract
Purpose: To assess the impact of individual surgeon experience on overall survival (OS), extent of resection (EOR) and surgery-related morbidity in elderly patients with glioblastoma (GBM), we performed a retrospective case-by-case analysis., Methods: GBM patients aged ≥ 65 years who underwent tumor resection at two academic centers were analyzed. The experience of each neurosurgeon was quantified in three ways: (1) total number of previously performed glioma surgeries (lifetime experience); (2) number of surgeries performed in the previous five years (medium-term experience) and (3) in the last two years (short-term experience). Surgeon experience data was correlated with survival (OS) and surrogate parameters for surgical quality (EOR, morbidity)., Results: 198 GBM patients (median age 73.0 years, median preoperative KPS 80, IDH-wildtype status 96.5%) were included. Median OS was 10.0 months (95% CI 8.0-12.0); median EOR was 89.4%. Surgery-related morbidity affected 19.7% patients. No correlations of lifetime surgeon experience with OS (P = .693), EOR (P = .693), and surgery-related morbidity (P = .435) were identified. Adjuvant therapy was associated with improved OS (P < .001); patients with surgery-related morbidity were less likely to receive adjuvant treatment (P = .002). In multivariable testing, adjuvant therapy (P < .001; HR = 0.064, 95%CI 0.028-0.144) remained the only significant predictor for improved OS., Conclusion: Less experienced neurosurgeons achieve similar surgical results and outcome in elderly GBM patients within the setting of academic teaching hospitals. Adjuvant treatment and avoidance of surgery-related morbidity are crucial for generating a treatment benefit for this cohort., (© 2023. The Author(s).)
- Published
- 2023
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