Abstract
PURPOSE: To evaluate the published evidence addressing supratotal resection in glioma, where supratotal is defined as resection beyond all MRI abnormalities present on T1 enhanced and FLAIR modalities.
METHODS
EMBASE, MEDLINE, Scopus, and Web of Science were queried using search terms designed to identify published works on supratotal resection. Records that were case studies, reviews or editorials, non-English, abstract-only, brain metastases, or only descriptive, were excluded. All others were included.
RESULTS
309 unique references yielded 41 studies for full-text review, with 7 included in the final analysis. Five originated from research in France, one from Germany, and one from Italy. All five French studies focused on low-grade glioma, whereas the remaining two focused on glioblastoma. A total of 88 patients had undergone supratotal resection in a combined cohort of 492 patients (214 males and 278 females, age 18 to 82 years). Fifty-one supratotal resections were conducted on high-grade gliomas, and 37 on low-grade gliomas. Surgical resection technologies included intraoperative MRI, cortical and subcortical functional testing, and 5-aminolevulinic acid. Studies were mostly of Oxford Center for Evidence-Based Medicine Level 4 quality. Karnofsky Performance Status, overall survival, progression-free survival, neurological deficits post-operatively, and anaplastic transformation were the main measured outcomes. No randomized controlled trials were identified. Preliminary low quality support was found for supratotal resection in increasing overall survival and progression-free survival for both low-grade and high-grade glioma.
CONCLUSION
The literature suggests insufficient evidence for carte blanche application of supratotal resection, particularly in lower grade gliomas where neurological deficits can result in long-term disability. Current evidence consists of data from only a few centers without independent validation. There is a definite need for further research with larger patient populations, clearly defined metrics and comparisons to evaluate improvements by, and the involvement of multi-national/multi-center research groups.