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Zattra CM, Zhang DY, Broggi M, Velz J, Vasella F, Seggewiss D, Schiavolin S, Bozinov O, Krayenbühl N, Sarnthein J, Ferroli P, Regli L, Stienen MN. Repeated craniotomies for intracranial tumors: is the risk increased? Pooled analysis of two prospective, institutional registries of complications and outcomes. J Neurooncol 2018; 142:49-57. [PMID: 30474767 PMCID: PMC6399174 DOI: 10.1007/s11060-018-03058-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Abstract
Purpose Deciding whether to re-operate patients with intracranial tumor recurrence or remnant is challenging, as the data on safety of repeated procedures is limited. This study set out to evaluate the risks for morbidity, mortality, and complications after repeated operations, and to compare those to primary operations. Methods Retrospective observational two-center study on consecutive patients undergoing microsurgical tumor resection. The data derived from independent, prospective institutional registries. The primary endpoint was morbidity at 3 months (M3), defined as significant decrease on the Karnofsky Performance Scale (KPS). Secondary endpoints were mortality, rate and severity of complications according to the Clavien–Dindo Grade (CDG). Results 463/2403 (19.3%) were repeated procedures. Morbidity at M3 occurred in n = 290 patients (12.1%). In univariable analysis, patients undergoing repeated surgery were 98% as likely as patients undergoing primary surgery to experience morbidity (OR 0.98, 95% CI 0.72–1.34, p = 0.889). In multivariable analysis adjusted for age, sex, tumor size, histology and posterior fossa location, the relationship remained stable (aOR 1.25, 95% CI 0.90–1.73, p = 0.186). Mortality was n = 10 (0.4%) at discharge and n = 95 (4.0%) at M3, without group differences. At least one complication occurred in n = 855, and the rate (35.5% vs. 35.9%, p = 0.892) and severity (CDG; p = 0.520) was similar after primary and repeated procedures. Results were reproduced in subgroup analyses for meningiomas, gliomas and cerebral metastases. Conclusions Repeated surgery for intracranial tumors does not increase the risk of morbidity. Mortality, and both the rate and severity of complications are comparable to primary operations. This information is of value for patient counseling and the informed consent process. Electronic supplementary material The online version of this article (10.1007/s11060-018-03058-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Costanza Maria Zattra
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - David Y Zhang
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Morgan Broggi
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Julia Velz
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Flavio Vasella
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Dominik Seggewiss
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Silvia Schiavolin
- Public Health and Disability Unit, Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Niklaus Krayenbühl
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Johannes Sarnthein
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Paolo Ferroli
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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Stienen MN, Zhang DY, Broggi M, Seggewiss D, Villa S, Schiavolin S, Bozinov O, Krayenbühl N, Sarnthein J, Ferroli P, Regli L. The influence of preoperative dependency on mortality, functional recovery and complications after microsurgical resection of intracranial tumors. J Neurooncol 2018; 139:441-448. [DOI: 10.1007/s11060-018-2882-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/24/2018] [Indexed: 10/17/2022]
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