Association Between Supratotal Glioblastoma Resection and Patient Survival: A Systematic Review and Meta-Analysis

BACKGROUND:Gross total resection (GTR) of the contrast enhancing (CE) area will improve the survival of patients with glioblastoma (GBM). However, GBM can infiltrate into the brain parenchyma, beyond the CE margins. It remains unclear whether resection beyond the CE area (supratotal resection [SPTR]) can improve survival without causing additional neurological deficits. The aim of the present meta-analysis was to study the association between SPTR and overall survival of patients of GBM. METHODS:Embase, PubMed, and other literature databases were searched for eligible studies until August 2018. Studies involving patients with GBM that had compared SPTR with GTR were included in the present study. The main outcome was overall survival, presented as hazard ratios (HRs) with 95% confidence intervals (CIs) and median overall survival differences with the 95% CIs. RESULTS:The meta-analysis, which included 6 studies and 1168 unique patients with GBM, showed that compared with GTR, SPTR of GBM resulted in a 53% lower risk of mortality at any time during follow-up (HR, 0.47; 95% CI, 0.31-0.72; P = 0.0005). The median overall survival of the SPTR group was 6.4 months (95% CI, 3.2-9.7) longer than the GTR group (P = 0.0001). Reports on postoperative deficits were limited, and the quality of evidence was moderate to very low. CONCLUSIONS:Compared with GTR, SPTR of GBM resulted in a lower risk of mortality and longer median overall survival. However, the quality of evidence of the available studies was poor. Therefore, it remains unclear whether SPTR is safe and actually improves the survival of patients with GBM. Future prospective trials and a standardized definition of SPTR are needed.