title: Operability of glioblastomas: "sins of action" versus "sins of non-action".
abstract: Despite prognosis of glioblastomas is still poor, mounting evidence suggests that more extensive surgical resections are associated with longer life expectancy. However, the surgical indications, at present, are far from uniform and the concept of operability is extremely surgeon-dependant. The results of glioblastoma resection in 104 patients operated on between March 2005 and April 2011 were reviewed with the aim to shed some light on the limits between 'sins of action' (operating upon complex tumors causing a permanent severe deficit) and 'sins of non-action' (considering inoperable tumors that can be resected with good results). Fifty-five patients (54.4 %) (Group 1) presented with a 'disputable' surgical indication because of one or more of the following clinico-radiological aspects: involvement of motor and language areas (39.4 %), deep location (7.7 %), corpus callosum infiltration (13.4 %), or major vessels encasement (8.6 %). Forty-six (42.5 %) patients (Group 2) presented with an 'indisputable' surgical indication (readily accessible tumors in non-eloquent areas). Overall mortality was 2.9 %. The mean overall survival was 19.8 months and not significantly different in the two Groups (20.4 Group 2 and 19.5 months for Group 1; p = 0.7). Patients with GTR and <72 years had a longer survival (p = 0.004 and 0.03, respectively). Seventy patients (69.3 %) showed an uneventful post-operative course, without statistical significance difference between Group 1 and 2. The gross total removal of glioblastoma with many complexities (Group 1) was found to be feasible with acceptable mortality, morbidity and long-term survival rates.
authors.affiliation: Department of Neurosurgery, Fondazione Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy, paolo.ferroli@istituto-besta.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferroli
authors.forename: Marco
authors.initials: M
authors.lastname: Schiariti
authors.forename: Gaetano
authors.initials: G
authors.lastname: Finocchiaro
authors.forename: Andrea
authors.initials: A
authors.lastname: Salmaggi
authors.forename: Melina
authors.initials: M
authors.lastname: Castiglione
authors.forename: Francesco
authors.initials: F
authors.lastname: Acerbi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tringali
authors.forename: Mariangela
authors.initials: M
authors.lastname: Farinotti
authors.forename: Morgan
authors.initials: M
authors.lastname: Broggi
authors.forename: Cordella
authors.initials: C
authors.lastname: Roberto
authors.forename: Elio
authors.initials: E
authors.lastname: Maccagnano
authors.forename: Giovanni
authors.initials: G
authors.lastname: Broggi
mesh_terms: D000368:Aged; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D016896:Treatment Outcome