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Acta Neurochirurgica
Published in: Acta Neurochirurgica 1/2024

01-12-2024 | Glioblastoma | Original Article

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

Authors: Maria Pia Tropeano, Luca Raspagliesi, Beatrice Claudia Bono, Ali Baram, Zefferino Rossini, Andrea Franzini, Pierina Navarria, Elena Clerici, Luisa Bellu, Matteo Simonelli, Marta Scorsetti, Marco Riva, Letterio Salvatore Politi, Federico Pessina

Published in: Acta Neurochirurgica | Issue 1/2024

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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.
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Metadata
Title
Supramaximal resection: retrospective study on IDH-wildtype Glioblastomas based on the new RANO-Resect classification
Authors
Maria Pia Tropeano
Luca Raspagliesi
Beatrice Claudia Bono
Ali Baram
Zefferino Rossini
Andrea Franzini
Pierina Navarria
Elena Clerici
Luisa Bellu
Matteo Simonelli
Marta Scorsetti
Marco Riva
Letterio Salvatore Politi
Federico Pessina
Publication date
01-12-2024
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 1/2024
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-024-06090-2

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