当前位置： SCI文献检索 > JOURNAL OF NEUROSURGERY期刊下所有文献 > Treatment by specialist surgical neurooncologists improves survival times for patients with malignant glioma.

Treatment by specialist surgical neurooncologists improves survival times for patients with malignant glioma.

Abstract：

OBJECT:Surgeries for CNS tumors are frequently performed by general neurosurgeons and by those who specialize in surgical neurooncology. Subspecialization in neurosurgical practice has become common and may improve patient morbidity and mortality rates. However, the potential benefits for patients of having their surgeries performed by surgical neurooncologists remain unclear. Recently, a shift in patient care to those who practice predominantly surgical neurooncology has been promoted. Evidence for this practice is lacking and therefore requires fundamental investigation. METHODS:The authors conducted a case-control study of neurooncology patients who underwent surgery for glioblastoma and anaplastic astrocytoma during 2006-2009. Outcomes were compared for patients whose surgery was performed by general neurosurgeons (generalists) or by specialist neurooncology neurosurgeons (specialists). An electronic record database and a picture archiving and communication system were used to collect data and assess the extent of tumor resection. Mortality rates and survival times were compared. Patient comorbidity and postoperative morbidity were assessed by using the Waterlow, patient handling, and falls risk assessment scores. Effects of case mix were adjusted for by using Cox regression and a hazards model. RESULTS:Outcomes for 135 patients (65 treated by generalists and 70 by specialists) were analyzed. Survival times were longer for patients whose surgery was performed by specialists (p=0.026) and after correction for case mix (p=0.019). Extent of tumor resection was greater when performed by specialists (p=0.005) and correlated with increased survival times (p=0.004). There was a trend toward reduced surgical deaths when surgery was performed by specialists (2.8%) versus generalists (7%) (p=0.102), and inpatient stays were significantly shorter when surgery was performed by specialists (p=0.008). CONCLUSIONS:The prognosis for glioblastoma multiforme remains dire, and improved treatments are urgently needed. This study provides evidence for a survival benefit when surgery is performed by specialist neurooncology neurosurgeons. The benefit might be attributable to increased tumor resection. Furthermore, specialist neurooncology surgical care may reduce the number of surgical patient deaths and length of inpatient stay. These findings support the recommendations for subspecialization within surgical neurooncology and advocate for care of these patients by specialists.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Khan UA,Bhavsar A,Asif H,Karabatsou K,Leggate JR,Sofat A,Kamaly-Asl ID

doi

10.3171/2014.10.JNS132057

subject

Has Abstract

pub_date

2015-02-01 00:00:00

pages

297-302

issue

eissn

0022-3085

issn

1933-0693

journal_volume

122

pub_type

杂志文章

在线工具

Treatment by specialist surgical neurooncologists improves survival times for patients with malignant glioma.