TY - JOUR
T1 - Patient selection and outcome in low-grade glioma surgery
AU - Jensdottir, Margret
AU - Solheim, Ole
AU - Corell, Alba
AU - de Dios, Eddie
AU - Dunås, Tora
AU - Fletcher-Sandersjöö, Alexander
AU - Gulati, Sasha
AU - Holmgren, Klas
AU - Latini, Francesco
AU - Mahesparan, Ruby
AU - Milos, Peter
AU - Neimantaite, Alice
AU - Redebrandt, Henrietta Nittby
AU - Pedersen, Lars Kjelsberg
AU - Sjöberg, Rickard L.
AU - Sjögren, Björn
AU - Tomasevic, Gregor
AU - Tveiten, Øystein Vesterli
AU - Vecchio, Tomás Gómez
AU - Zetterling, Maria
AU - Bartek, Jiri
AU - Jakola, Asgeir S.
N1 - Publisher Copyright:
Copyright © 2025 Jensdottir, Solheim, Corell, de Dios, Dunås, Fletcher-Sandersjöö, Gulati, Holmgren, Latini, Mahesparan, Milos, Neimantaite, Redebrandt, Pedersen, Sjöberg, Sjögren, Tomasevic, Tveiten, Vecchio, Zetterling, Bartek and Jakola.
PY - 2025
Y1 - 2025
N2 - Background and objectives: Maximal safe resection is the cornerstone of diffuse low-grade glioma (dLGG) management, although epidemiological data are limited. We aim to explore surgical selection, techniques, and outcomes in a population-based cohort. Materials and methods: This study utilized a multi-center case series (9 out of 10 neurosurgical departments in Norway and Sweden) of all adults (≥18 years) with histopathologically verified supratentorial dLGG, WHO grade 2, undergoing primary surgery from 2012-2017. Complications within 30 days and neurological outcomes at 3 months were assessed. Pre- and postoperative MRIs were reviewed centrally, blinded to patient outcome and center. Results: Of 517 included patients, 217 (41.7%) were female, and the mean (SD) age was 44.5 (15.0) years. Biopsy only was performed in 119 (23.0%) patients (13.8-38.9% across centers), and 398 (77.0%) underwent resection (61.1-86.2%). Intraoperative neurophysiological monitoring (IONM) was used in 142 (35.7%, 0-58.7%) resections. The biopsy-only patients were older (52.7 years vs. 42.1 years, P<.001), had larger tumors (56.6 ml vs. 31.9 ml, P<.001), and these tumors were more often eloquently located (86.6% vs. 56.5%, P<.001). The median (IQR) extent of resection (EOR) was 82.9% (63.3-97.7%), 69.7-100.0% across centers. The median (IQR) residual tumor was 4.6 ml (0.5-19.9 ml), 0.0-14.1 ml across centers. Age and histopathology were the most important predictors of EOR. New/worsened neurological deficits occurred in 165 patients (41.5%), 23.1-66.7% across centers, and persisted in 19 (4.8%, 0-22.7%) at 3 months after surgery. A complication was observed in 87 patients (21.4%, 0-31.7%), with 12 patients (3.1%, 0-9.8%) having grade III-IV complications. Conclusions: We found that surgical selection was associated with age, tumor size, and location. The median EOR in a population-based cohort was 83%, with age and tumor biology being significant predictors. EOR did not correlate with higher risks or worse neurological outcomes. We provide an epidemiological perspective demonstrating a variation in surgical selection and techniques reflecting persistent controversy in dLGG management.
AB - Background and objectives: Maximal safe resection is the cornerstone of diffuse low-grade glioma (dLGG) management, although epidemiological data are limited. We aim to explore surgical selection, techniques, and outcomes in a population-based cohort. Materials and methods: This study utilized a multi-center case series (9 out of 10 neurosurgical departments in Norway and Sweden) of all adults (≥18 years) with histopathologically verified supratentorial dLGG, WHO grade 2, undergoing primary surgery from 2012-2017. Complications within 30 days and neurological outcomes at 3 months were assessed. Pre- and postoperative MRIs were reviewed centrally, blinded to patient outcome and center. Results: Of 517 included patients, 217 (41.7%) were female, and the mean (SD) age was 44.5 (15.0) years. Biopsy only was performed in 119 (23.0%) patients (13.8-38.9% across centers), and 398 (77.0%) underwent resection (61.1-86.2%). Intraoperative neurophysiological monitoring (IONM) was used in 142 (35.7%, 0-58.7%) resections. The biopsy-only patients were older (52.7 years vs. 42.1 years, P<.001), had larger tumors (56.6 ml vs. 31.9 ml, P<.001), and these tumors were more often eloquently located (86.6% vs. 56.5%, P<.001). The median (IQR) extent of resection (EOR) was 82.9% (63.3-97.7%), 69.7-100.0% across centers. The median (IQR) residual tumor was 4.6 ml (0.5-19.9 ml), 0.0-14.1 ml across centers. Age and histopathology were the most important predictors of EOR. New/worsened neurological deficits occurred in 165 patients (41.5%), 23.1-66.7% across centers, and persisted in 19 (4.8%, 0-22.7%) at 3 months after surgery. A complication was observed in 87 patients (21.4%, 0-31.7%), with 12 patients (3.1%, 0-9.8%) having grade III-IV complications. Conclusions: We found that surgical selection was associated with age, tumor size, and location. The median EOR in a population-based cohort was 83%, with age and tumor biology being significant predictors. EOR did not correlate with higher risks or worse neurological outcomes. We provide an epidemiological perspective demonstrating a variation in surgical selection and techniques reflecting persistent controversy in dLGG management.
KW - extent of resection
KW - glioma
KW - low-grade glioma
KW - neurological deficits
KW - neurosurgery
KW - oncology
KW - surgical outcomes
UR - https://www.scopus.com/pages/publications/105025055762
U2 - 10.3389/fonc.2025.1703756
DO - 10.3389/fonc.2025.1703756
M3 - Journal article
C2 - 41395619
AN - SCOPUS:105025055762
SN - 2234-943X
VL - 15
JO - Frontiers in Oncology
JF - Frontiers in Oncology
M1 - 1703756
ER -