Introduction: Gross total resection (GTR) has been proposed to improve the outcomes of patients with low-grade glioma (LGG). Despite this, the value of the extent of resection (EOR) for LGG remains controversial.
Methods: We conducted a systematic review and meta-analysis to compare biopsy vs subtotal resection (STR) vs GTR vs resection of any extent in patients with LGG. For each comparison we examined 7 outcomes including overall survival, postoperative Karnofsky performance status, progression-free survival, mortality, morbidity, malignant transformation, and postoperative seizure control. We summarized our analyses using relative risks (RR) with corresponding 95% confidence intervals (CI) for dichotomous outcomes, and weighted mean differences (MD) with 95% CI for continuous outcomes.
Results: We included 54 studies totaling 7,046 patients. Resection of any extent was observed to be favorable to biopsy when examining overall survival (MD 2.42, 95% CI: 1.09–3.75, P<0.001) as well as postoperative seizure control (RR 0.18, 95% CI: 0.02–1.48, P=0.110). Moreover, GTR was associated with higher overall survival (MD 3.91, 95% CI: 1.86–5.96, P<0.001) and better seizure control postoperatively (RR 0.75, 95% CI: 0.44–1.29, P=0.300) when compared to STR.
Conclusions: Our findings suggest an upward improvement in survival time and seizure control associated with increasing extents of safe resection. Total gross resection was associated with optimal results if considered in conjunction with established safety measures.
Patient Care: Our data from comprehensive meta-analysis suggest that gross-total resection is associated with improved survival and postoperative seizure control. We therefore advocate for gross total resection of LGGs to achieve optimal care.
Learning Objectives: 1) present data that examine the efficacy and safety of gross-total resection in the management of low-grade glioma
2) discuss different management strategies at different centers
3) advocate for gross total resection in LGG patients