Early re-do surgery for glioblastoma is a feasible and safe strategy to achieve complete resection of enhancing tumor.

<h4>Background</h4>Complete resection of enhancing tumor as assessed by early (<72 hours) postoperative MRI is regarded as the optimal result in glioblastoma surgery. As yet, there is no consensus on standard procedure if post-operative imaging reveals unintended tumor remnants.<h4...

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Autores principales:	Philippe Schucht, Michael Murek, Astrid Jilch, Kathleen Seidel, Ekkehard Hewer, Roland Wiest, Andreas Raabe, Jürgen Beck
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/dbb6a09ae2194f61b0c48790fcc7e1ef
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spelling	oai:doaj.org-article:dbb6a09ae2194f61b0c48790fcc7e1ef2021-11-18T08:46:38ZEarly re-do surgery for glioblastoma is a feasible and safe strategy to achieve complete resection of enhancing tumor.1932-620310.1371/journal.pone.0079846https://doaj.org/article/dbb6a09ae2194f61b0c48790fcc7e1ef2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24348904/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Complete resection of enhancing tumor as assessed by early (<72 hours) postoperative MRI is regarded as the optimal result in glioblastoma surgery. As yet, there is no consensus on standard procedure if post-operative imaging reveals unintended tumor remnants.<h4>Objective</h4>The current study evaluated the feasibility and safety of an early re-do surgery aimed at completing resections with the aid of 5-ALA fluorescence and neuronavigation after detection of enhancing tumor remnants on post-operative MRI.<h4>Methods</h4>From October 2008 to October 2012 a single center institutional protocol offered a second surgery within one week to patients with unintentional incomplete glioblastoma resection. We report on the feasibility of the use 5-ALA fluorescence guidance, the extent of resection (EOR) rates and complications of early re-do surgery.<h4>Results</h4>Nine of 151 patients (6%) with glioblastoma resections had an unintentional tumor remnant with a volume >0.175 cm(3). 5-ALA guided re-do surgery completed the resection (CRET) in all patients without causing neurological deficits, infections or other complications. Patients who underwent a re-do surgery remained hospitalized between surgeries, resulting in a mean length of hospital stay of 11 days (range 7-15), compared to 9 days for single surgery (range 3-23; p=0.147).<h4>Conclusion</h4>Our early re-do protocol led to complete resection of all enhancing tumor in all cases without any new neurological deficits and thus provides a similar oncological result as intraoperative MRI (iMRI). The repeated use of 5-ALA induced fluorescence, used for identification of small remnants, remains highly sensitive and specific in the setting of re-do surgery. Early re-do surgery is a feasible and safe strategy to complete unintended subtotal resections.Philippe SchuchtMichael MurekAstrid JilchKathleen SeidelEkkehard HewerRoland WiestAndreas RaabeJürgen BeckPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 11, p e79846 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Philippe Schucht Michael Murek Astrid Jilch Kathleen Seidel Ekkehard Hewer Roland Wiest Andreas Raabe Jürgen Beck Early re-do surgery for glioblastoma is a feasible and safe strategy to achieve complete resection of enhancing tumor.
description	<h4>Background</h4>Complete resection of enhancing tumor as assessed by early (<72 hours) postoperative MRI is regarded as the optimal result in glioblastoma surgery. As yet, there is no consensus on standard procedure if post-operative imaging reveals unintended tumor remnants.<h4>Objective</h4>The current study evaluated the feasibility and safety of an early re-do surgery aimed at completing resections with the aid of 5-ALA fluorescence and neuronavigation after detection of enhancing tumor remnants on post-operative MRI.<h4>Methods</h4>From October 2008 to October 2012 a single center institutional protocol offered a second surgery within one week to patients with unintentional incomplete glioblastoma resection. We report on the feasibility of the use 5-ALA fluorescence guidance, the extent of resection (EOR) rates and complications of early re-do surgery.<h4>Results</h4>Nine of 151 patients (6%) with glioblastoma resections had an unintentional tumor remnant with a volume >0.175 cm(3). 5-ALA guided re-do surgery completed the resection (CRET) in all patients without causing neurological deficits, infections or other complications. Patients who underwent a re-do surgery remained hospitalized between surgeries, resulting in a mean length of hospital stay of 11 days (range 7-15), compared to 9 days for single surgery (range 3-23; p=0.147).<h4>Conclusion</h4>Our early re-do protocol led to complete resection of all enhancing tumor in all cases without any new neurological deficits and thus provides a similar oncological result as intraoperative MRI (iMRI). The repeated use of 5-ALA induced fluorescence, used for identification of small remnants, remains highly sensitive and specific in the setting of re-do surgery. Early re-do surgery is a feasible and safe strategy to complete unintended subtotal resections.
format	article
author	Philippe Schucht Michael Murek Astrid Jilch Kathleen Seidel Ekkehard Hewer Roland Wiest Andreas Raabe Jürgen Beck
author_facet	Philippe Schucht Michael Murek Astrid Jilch Kathleen Seidel Ekkehard Hewer Roland Wiest Andreas Raabe Jürgen Beck
author_sort	Philippe Schucht
title	Early re-do surgery for glioblastoma is a feasible and safe strategy to achieve complete resection of enhancing tumor.
title_short	Early re-do surgery for glioblastoma is a feasible and safe strategy to achieve complete resection of enhancing tumor.
title_full	Early re-do surgery for glioblastoma is a feasible and safe strategy to achieve complete resection of enhancing tumor.
title_fullStr	Early re-do surgery for glioblastoma is a feasible and safe strategy to achieve complete resection of enhancing tumor.
title_full_unstemmed	Early re-do surgery for glioblastoma is a feasible and safe strategy to achieve complete resection of enhancing tumor.
title_sort	early re-do surgery for glioblastoma is a feasible and safe strategy to achieve complete resection of enhancing tumor.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/dbb6a09ae2194f61b0c48790fcc7e1ef
work_keys_str_mv	AT philippeschucht earlyredosurgeryforglioblastomaisafeasibleandsafestrategytoachievecompleteresectionofenhancingtumor AT michaelmurek earlyredosurgeryforglioblastomaisafeasibleandsafestrategytoachievecompleteresectionofenhancingtumor AT astridjilch earlyredosurgeryforglioblastomaisafeasibleandsafestrategytoachievecompleteresectionofenhancingtumor AT kathleenseidel earlyredosurgeryforglioblastomaisafeasibleandsafestrategytoachievecompleteresectionofenhancingtumor AT ekkehardhewer earlyredosurgeryforglioblastomaisafeasibleandsafestrategytoachievecompleteresectionofenhancingtumor AT rolandwiest earlyredosurgeryforglioblastomaisafeasibleandsafestrategytoachievecompleteresectionofenhancingtumor AT andreasraabe earlyredosurgeryforglioblastomaisafeasibleandsafestrategytoachievecompleteresectionofenhancingtumor AT jurgenbeck earlyredosurgeryforglioblastomaisafeasibleandsafestrategytoachievecompleteresectionofenhancingtumor
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Early re-do surgery for glioblastoma is a feasible and safe strategy to achieve complete resection of enhancing tumor.

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