Journal article
Extent of resection of epidermoid tumors and risk of recurrence: case report and meta-analysis
Journal of neurosurgery, v 133(2), pp 291-301
01 Aug 2020
PMID: 31277071
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
OBJECTIVE Intracranial epidermoid tumors are slow-growing, histologically benign tumors of epithelial cellular origin that can be symptomatic because of their size and mass effect. Neurosurgical resection, while the treatment of choice, can be quite challenging due to locations where these lesions commonly occur and their association with critical neurovascular structures. As such, subtotal resection (STR) rather than gross-total resection (GTR) can often be performed, rendering residual and recurrent tumor potentially problematic. The authors present a case of a 28-year-old man who underwent STR followed by aggressive repeat resection for regrowth, and they report the results of the largest meta-analysis to date of epidermoid tumors to compare recurrence rates for STR and GTR.
METHODS The authors conducted a systemic review of PubMed, Web of Science, and the Cochrane Collaboration following the PRISMA guidelines. They then conducted a proportional meta-analysis to compare the pooled recurrence rates between STR and GTR in the included studies. The authors developed fixed- and mixed-effect models to estimate the pooled proportions of recurrence among patients undergoing STR or GTR. They also investigated the relationship between recurrence rate and follow-up time in the previous studies using linear regression and natural cubic spline models.
RESULTS Overall, 27 studies with 691 patients met the inclusion criteria; of these, 293 (42%) underwent STR and 398 (58%) received GTR. The average recurrence rate for all procedures was 11%. The proportional meta-analysis showed that the pooled recurrence rate after STR (21%) was 7 times greater than the rate after GTR (3%). The average recurrence rate for studies with longer follow-up durations (>= 4.4 years) (17.4%) was significantly higher than the average recurrence rate for studies with shorter follow-up durations (< 4.4 years) (5.7%). The cutoff point of 4.4 years was selected based on the significant relationship between the recurrence rate of both STR and GTR and follow-up durations in the included studies (p = 0.008).
CONCLUSIONS STR is associated with a significantly higher rate of epidermoid tumor recurrence compared to GTR. Attempts at GTR should be made during the initial surgery with efforts to optimize success. Surgical expertise, as well as the use of adjuncts, such as intraoperative MRI and neuromonitoring, may increase the likelihood of completing a safe GTR and decreasing the long-term risk of recurrence. The most common surgical complications were transient cranial nerve palsies, occurring equally in STR and GTR cases when reported. In all postoperative epidermoid tumor cases, but particularly following STR, close follow-up with serial MRI, even years after surgery, is recommended.
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Details
- Title
- Extent of resection of epidermoid tumors and risk of recurrence: case report and meta-analysis
- Creators
- Brian M. Shear - College Station Medical CenterLan Jin - Yale UniversityYawei Zhang - Yale UniversityWyatt B. David - College Station Medical CenterElena Fomchenko - College Station Medical CenterE. Zeynep Erson-Omay - College Station Medical CenterAnita Huttner - College Station Medical CenterRobert K. Fulbright - Yale UniversityJennifer Moliterno - College Station Medical Center
- Publication Details
- Journal of neurosurgery, v 133(2), pp 291-301
- Publisher
- Amer Assoc Neurological Surgeons
- Number of pages
- 11
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology
- Web of Science ID
- WOS:000586087300003
- Scopus ID
- 2-s2.0-85088105294
- Other Identifier
- 991022004958804721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Clinical Neurology
- Surgery