title: The Safety of Surgery in Elderly Patients with Primary and Recurrent Glioblastoma.
abstract: BACKGROUND
  Glioblastoma (GBM) occurs more commonly in elderly patients. However, these patients are often excluded from clinical trials. The absence of solid evidence has resulted in a nihilistic view of GBM in the elderly and a traditionally conservative treatment approach. In particular, the safety of surgical resection for both primary and recurrent GBM is poorly understood in elderly patients.
  
  
  METHODS
  In a retrospective cohort of patients aged ≥65 years, we examined selection for biopsy, surgical resection, and reoperation for recurrent disease. We also analyzed complication rates after initial resection and reoperation for recurrent disease. We identified 319 elderly patients with pathologically proven GBM who underwent a total of 274 craniotomies at our institution between 2000 and 2012. Events were reported according to the methods used in the Glioma Outcomes Project.
  
  
  RESULTS
  The overall rate of complications after resection was 21.9%, with a rate of neurological complications of 7.7%. The rates of neurological, regional, and systemic complications were not significantly different after initial craniotomy and reoperation for GBM in elderly patients. Reoperations were not associated with an increased risk of complications. Low cardiovascular risk, improved functional status, and hemispheric GBM were associated with selection for more aggressive surgical treatment. Younger age and improved functional status were associated with a reduced likelihood of complications.
  
  
  CONCLUSIONS
  We conclude that in select patients, age alone should not preclude the decision to pursue aggressive surgical management.
authors.affiliation: Gabriele Bartoli Brain Tumor Research Laboratory, Columbia University College of Physicians and Surgeons, New York, New York, USA; Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA.
authors.forename: Randy S
authors.initials: RS
authors.lastname: D'Amico
authors.affiliation: Gabriele Bartoli Brain Tumor Research Laboratory, Columbia University College of Physicians and Surgeons, New York, New York, USA. Electronic address: mbc2121@cumc.columbia.edu.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Cloney
authors.affiliation: Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Sonabend
authors.affiliation: Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA.
authors.forename: Brad
authors.initials: B
authors.lastname: Zacharia
authors.affiliation: Gabriele Bartoli Brain Tumor Research Laboratory, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Matthew N
authors.initials: MN
authors.lastname: Nazarian
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, New York, USA.
authors.forename: Fabio M
authors.initials: FM
authors.lastname: Iwamoto
authors.affiliation: Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Sisti
authors.affiliation: Gabriele Bartoli Brain Tumor Research Laboratory, Columbia University College of Physicians and Surgeons, New York, New York, USA; Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Bruce
authors.affiliation: Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA.
authors.forename: Guy M
authors.initials: GM
authors.lastname: McKhann
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000601:surgery*; D015331:Cohort Studies; D003399:Craniotomy / Q000009:adverse effects* / Q000592:standards; D005260:Female; D005909:Glioblastoma / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Complications; Craniotomy; Elderly; Glioblastoma; Recurrent glioblastoma