The Impact of Perioperative Arterial Infarct on Recurrence, Functional Outcomes, and Survival in Glioblastoma Patients
Background: Perioperative infarcts are a known complication that can occur during the resection of glioblastoma (GBM). Recent studies suggest that gross total and even “supra-total” resections may be associated with an increased survival but the rate of complications, including perioperative ischemi...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2020-05-01
|
| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/article/10.3389/fonc.2020.00706/full |
| _version_ | 1828752501098151936 |
|---|---|
| author | Jakob T. Lupa Jeffrey J. Raizer Irene B. Helenowski Benjamin P. Liu Benjamin P. Liu Kartik Kesavabhotla Matthew C. Tate Matthew C. Tate |
| author_facet | Jakob T. Lupa Jeffrey J. Raizer Irene B. Helenowski Benjamin P. Liu Benjamin P. Liu Kartik Kesavabhotla Matthew C. Tate Matthew C. Tate |
| author_sort | Jakob T. Lupa |
| collection | DOAJ |
| description | Background: Perioperative infarcts are a known complication that can occur during the resection of glioblastoma (GBM). Recent studies suggest that gross total and even “supra-total” resections may be associated with an increased survival but the rate of complications, including perioperative ischemia, may increase with these more aggressive resection strategies. However, little is known about the impact that perioperative infarcts have on survival, functional outcomes, and tumor recurrence patterns. Our study attempted to quantify and characterize the functional consequences of a perioperative infarct, as well as risk factors associated with occurrence.Methods: Seventy-three patients with a diagnosis of GBM and perioperative ischemia by MRI were identified from the electronic medical record system. We obtained demographic, prognostic, and stroke risk factor data. Infarct volumes were calculated from diffusion-weighted MRI scans, and subjects were segregated into an infarct cohort or a control cohort based on whether the identified lesion appeared to be an infarct in an arterial distribution or instead appeared to be expected postoperative changes. A multivariate statistical analysis was performed on the dataset.Results: Median age was 58.6 years, median post-op KPS (Karnofsky Performance Status) was 90, and median extent of resection (based on MRI) was 97.8%. Overall, perioperative arterial infarcts were uncommon (2.0%), did not have a statistically significant impact on survival (17.9 vs. 18.9 months), did not worsen neurologic function, and did not alter the pattern of recurrence.Conclusion: Perioperative arterial infarcts were uncommon in our patients despite aggressive resection and when present had no impact on survival or neurologic function. Given the clear benefit of maximal tumor resection, the risk of perioperative infarct should not deter maximal safe resection. |
| first_indexed | 2024-12-10T21:10:44Z |
| format | Article |
| id | doaj.art-2765d77409354b369ff61372b48be424 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-10T21:10:44Z |
| publishDate | 2020-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-2765d77409354b369ff61372b48be4242022-12-22T01:33:29ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2020-05-011010.3389/fonc.2020.00706542247The Impact of Perioperative Arterial Infarct on Recurrence, Functional Outcomes, and Survival in Glioblastoma PatientsJakob T. Lupa0Jeffrey J. Raizer1Irene B. Helenowski2Benjamin P. Liu3Benjamin P. Liu4Kartik Kesavabhotla5Matthew C. Tate6Matthew C. Tate7Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United StatesDepartment of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United StatesDepartment of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United StatesDepartment of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United StatesDepartment of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United StatesDepartment of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United StatesDepartment of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United StatesDepartment of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United StatesBackground: Perioperative infarcts are a known complication that can occur during the resection of glioblastoma (GBM). Recent studies suggest that gross total and even “supra-total” resections may be associated with an increased survival but the rate of complications, including perioperative ischemia, may increase with these more aggressive resection strategies. However, little is known about the impact that perioperative infarcts have on survival, functional outcomes, and tumor recurrence patterns. Our study attempted to quantify and characterize the functional consequences of a perioperative infarct, as well as risk factors associated with occurrence.Methods: Seventy-three patients with a diagnosis of GBM and perioperative ischemia by MRI were identified from the electronic medical record system. We obtained demographic, prognostic, and stroke risk factor data. Infarct volumes were calculated from diffusion-weighted MRI scans, and subjects were segregated into an infarct cohort or a control cohort based on whether the identified lesion appeared to be an infarct in an arterial distribution or instead appeared to be expected postoperative changes. A multivariate statistical analysis was performed on the dataset.Results: Median age was 58.6 years, median post-op KPS (Karnofsky Performance Status) was 90, and median extent of resection (based on MRI) was 97.8%. Overall, perioperative arterial infarcts were uncommon (2.0%), did not have a statistically significant impact on survival (17.9 vs. 18.9 months), did not worsen neurologic function, and did not alter the pattern of recurrence.Conclusion: Perioperative arterial infarcts were uncommon in our patients despite aggressive resection and when present had no impact on survival or neurologic function. Given the clear benefit of maximal tumor resection, the risk of perioperative infarct should not deter maximal safe resection.https://www.frontiersin.org/article/10.3389/fonc.2020.00706/fullglioblastomainfarctresectionrecurrencesurvival |
| spellingShingle | Jakob T. Lupa Jeffrey J. Raizer Irene B. Helenowski Benjamin P. Liu Benjamin P. Liu Kartik Kesavabhotla Matthew C. Tate Matthew C. Tate The Impact of Perioperative Arterial Infarct on Recurrence, Functional Outcomes, and Survival in Glioblastoma Patients Frontiers in Oncology glioblastoma infarct resection recurrence survival |
| title | The Impact of Perioperative Arterial Infarct on Recurrence, Functional Outcomes, and Survival in Glioblastoma Patients |
| title_full | The Impact of Perioperative Arterial Infarct on Recurrence, Functional Outcomes, and Survival in Glioblastoma Patients |
| title_fullStr | The Impact of Perioperative Arterial Infarct on Recurrence, Functional Outcomes, and Survival in Glioblastoma Patients |
| title_full_unstemmed | The Impact of Perioperative Arterial Infarct on Recurrence, Functional Outcomes, and Survival in Glioblastoma Patients |
| title_short | The Impact of Perioperative Arterial Infarct on Recurrence, Functional Outcomes, and Survival in Glioblastoma Patients |
| title_sort | impact of perioperative arterial infarct on recurrence functional outcomes and survival in glioblastoma patients |
| topic | glioblastoma infarct resection recurrence survival |
| url | https://www.frontiersin.org/article/10.3389/fonc.2020.00706/full |
| work_keys_str_mv | AT jakobtlupa theimpactofperioperativearterialinfarctonrecurrencefunctionaloutcomesandsurvivalinglioblastomapatients AT jeffreyjraizer theimpactofperioperativearterialinfarctonrecurrencefunctionaloutcomesandsurvivalinglioblastomapatients AT irenebhelenowski theimpactofperioperativearterialinfarctonrecurrencefunctionaloutcomesandsurvivalinglioblastomapatients AT benjaminpliu theimpactofperioperativearterialinfarctonrecurrencefunctionaloutcomesandsurvivalinglioblastomapatients AT benjaminpliu theimpactofperioperativearterialinfarctonrecurrencefunctionaloutcomesandsurvivalinglioblastomapatients AT kartikkesavabhotla theimpactofperioperativearterialinfarctonrecurrencefunctionaloutcomesandsurvivalinglioblastomapatients AT matthewctate theimpactofperioperativearterialinfarctonrecurrencefunctionaloutcomesandsurvivalinglioblastomapatients AT matthewctate theimpactofperioperativearterialinfarctonrecurrencefunctionaloutcomesandsurvivalinglioblastomapatients AT jakobtlupa impactofperioperativearterialinfarctonrecurrencefunctionaloutcomesandsurvivalinglioblastomapatients AT jeffreyjraizer impactofperioperativearterialinfarctonrecurrencefunctionaloutcomesandsurvivalinglioblastomapatients AT irenebhelenowski impactofperioperativearterialinfarctonrecurrencefunctionaloutcomesandsurvivalinglioblastomapatients AT benjaminpliu impactofperioperativearterialinfarctonrecurrencefunctionaloutcomesandsurvivalinglioblastomapatients AT benjaminpliu impactofperioperativearterialinfarctonrecurrencefunctionaloutcomesandsurvivalinglioblastomapatients AT kartikkesavabhotla impactofperioperativearterialinfarctonrecurrencefunctionaloutcomesandsurvivalinglioblastomapatients AT matthewctate impactofperioperativearterialinfarctonrecurrencefunctionaloutcomesandsurvivalinglioblastomapatients AT matthewctate impactofperioperativearterialinfarctonrecurrencefunctionaloutcomesandsurvivalinglioblastomapatients |