Supramaximal resection: retrospective study on IDH-wildtype Glioblastomas based on the new RANO-Resect classification

Acta Neurochir (Wien). 2024 Apr 27;166(1):196. doi: 10.1007/s00701-024-06090-2.

Abstract

Background: The prognostic value of the extent of resection in the management of Glioblastoma is a long-debated topic, recently widened by the 2022 RANO-Resect Classification, which advocates for the resection of the non-enhancing disease surrounding the main core of tumors (supramaximal resection, SUPR) to achieve additional survival benefits. We conducted a retrospective analysis to corroborate the role of SUPR by the RANO-Resect Classification in a single center, homogenous cohort of patients.

Methods: Records of patients operated for WHO-2021 Glioblastomas at our institution between 2007 and 2018 were retrospectively reviewed; volumetric data of resected lesions were computed and classified by RANO-Resect criteria. Survival and correlation analyses were conducted excluding patients below near-total resection.

Results: 117 patients met the inclusion criteria, encompassing 45 near-total resections (NTR), 31 complete resections (CR), and 41 SUPR. Median progression-free and overall survival were 11 and 15 months for NTR, 13 and 17 months or CR, 20 and 24 months for SUPR, respectively (p < 0.001), with inverse correlation observed between survival and FLAIR residual volume (r -0.28). SUPR was not significantly associated with larger preoperative volumes or higher rates of postoperative deficits, although it was less associated with preoperative neurological deficits (OR 3.37, p = 0.003). The impact of SUPR on OS varied between MGMT unmethylated (HR 0.606, p = 0.044) and methylated (HR 0.273, p = 0.002) patient groups.

Conclusions: Results of the present study support the validity of supramaximal resection by the new RANO-Resect classification, also highlighting a possible surgical difference between tumors with methylated and unmethylated MGMT promoter.

Keywords: Extent of Resection; Glioblastoma; RANO-Resect; Survival.

MeSH terms

  • Adult
  • Aged
  • Brain Neoplasms* / diagnostic imaging
  • Brain Neoplasms* / mortality
  • Brain Neoplasms* / pathology
  • Brain Neoplasms* / surgery
  • Female
  • Glioblastoma* / genetics
  • Glioblastoma* / mortality
  • Glioblastoma* / pathology
  • Glioblastoma* / surgery
  • Humans
  • Isocitrate Dehydrogenase* / genetics
  • Male
  • Middle Aged
  • Neurosurgical Procedures / methods
  • Retrospective Studies

Substances

  • Isocitrate Dehydrogenase