Introduction: The role of repeat surgery at glioblastoma recurrence remains ill defined. This study aims to quantify the effect of repeat surgery in recurrent GBM on overall survival (OS) and determine if a trend in reported effect over time exists.
Methods: Searches of seven electronic databases from inception to January 2018 were conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. There were 2692 articles identified for screening. Prognostic hazard ratios (HRs) derived from multivariate regression analysis were extracted, and analyzed using meta-analysis of proportions and linear regression.
Results: Eight observational studies reporting prognostic HRs in 10 cohorts were included. They described 1906 recurrent GBM diagnoses, managed by surgery at primary diagnosis, with 709 (37%) undergoing reoperation at recurrence. Repeat surgery was shown to confer a statistically significant survival advantage compared to no surgery at recurrence in the pooled cohort (HR, 0.722; p<0.001). Newer studies trended towards a superior prognostic advantage of repeat surgery when compared to earlier studies (effect coefficient, 0.856; p=0.012).
Conclusions: This meta-analysis of contemporary literature suggests repeat surgery at GBM recurrence in select patients confers a significant, independent, prognostic OS advantage. Furthermore, newer studies are significantly more likely to suggest greater benefit than older studies. The main limitation is the selection bias inherent in the cohorts pooled for analysis. Larger prospective, randomized controlled studies are needed to validate the findings of this study.
Patient Care: 1. A prospective, multicenter trial to further define the role of reoperation for GBM recurrence will be motivated
2. In the meantime, patients with recurrent GBM who are appropriately selected can be offered life extending intervention that is evidence based.
Learning Objectives: By the conclusion of this presentation, participants will be able to
1. Discuss the evidence supporting the role of reoperation for GBM recurrence
2. Identify sources of bias in a meta-analysis