Brain Cancer Progression: A Retrospective Multicenter Comparison of Awake Craniotomy Versus General Anesthesia in High-grade Glioma Resection

Abstract

Background: High-grade gliomas impose substantial morbidity and mortality due to rapid cancer progression and recurrence. Factors such as surgery, chemotherapy and radiotherapy remain the cornerstones for treatment of brain cancer and brain cancer research. The role of anesthetics on glioma progression is largely unknown.Methods: This multicenter retrospective cohort study compared patients who underwent high-grade glioma resection with minimal sedation (awake craniotomy) and those who underwent craniotomy with general anesthesia (GA). Various perioperative factors, intraoperative and postoperative complications, and adjuvant treatment regimens were recorded. The primary outcome was progression-free survival (PFS); secondary outcomes were overall survival (OS), postoperative pain score, and length of hospital stay.Results: A total of 891 patients were included; 79% received GA, and 21% underwent awake craniotomy. There was no difference in median PFS between awake craniotomy (0.54, 95% confidence interval [CI]: 0.45-0.65 y) and GA (0.53, 95% CI: 0.48-0.60 y) groups (hazard ratio 1.05; P < 0.553). Median OS was significantly longer in the awake craniotomy (1.70, 95% CI: 1.30-2.32 y) compared with that in the GA (1.25, 95% CI: 1.15-1.37 y) group (hazard ratio 0.76; P < 0.009) but this effect did not persist after controlling for other variables of interest. Median length of hospital stay was significantly shorter in the awake craniotomy group (2 [range: 0 to 76], interquartile range 3 d vs. 5 [0 to 98], interquartile range 5 for awake craniotomy and GA groups, respectively; P < 0.001). Pain scores were comparable between groups.Conclusions: There was no difference in PFS and OS between patients who underwent surgical resection of high-grade glioma with minimal sedation (awake craniotomy) or GA. Further large prospective randomized controlled studies are needed to explore the role of anesthetics on glioma progression and patient survival.

Awake craniotomy for high-grade gliomas – a prospective cohort study in a UK tertiary-centre

“…However, this is a metaanalysis of observational/retrospective studies as the study authors have claimed. A retrospective multicentre study (891 patients) comparing AC (21%) and GA (79%) for HGG surgery found no difference in median PFS or median OS [7]. The recent multi-centre cohort study (GLIOMAP) by Gerritsen et al [17] on the effect of AC in glioblastoma in eloquent areas reported longer median PFS and median OS in AC versus asleep for cohort younger than 70 years (PFS: 9 The median PFS and median OS of 13 and 30 months, respectively in our study were also comparable to the numbers reported in literature [7,16,17].…”

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2022

“…In a multicenter retrospective study by Chowdhury et al, they compared the effect of awake craniotomy (AC) versus general anesthesia (GA) on progression-free survival (PFS) and overall survival (OS) in patients with high-grade gliomas undergoing surgical resection. 3 A total of 891 patients across five centers were included. The two groups were similar with respect to age, sex, location of the tumor, and preoperative Karnofsky Performance Status.…”

Editorial: Advances in surgical approaches for the treatment of glioma

“…Compared with awake surgery, surgery under general anesthesia is less time-consuming, with lower intraoperative risk ( 9 , 10 ). Cui et al.…”