Review of Current Evidence Regarding Surgery in Elderly Patients with Meningioma

Ikawa, Fusao; Kinoshita, Yasuyuki; Takeda, Masaaki; Saito, Taiichi; Yamaguchi, Satoshi; Yamasaki, Fumiyuki; Iida, Koji; Sakamoto, Kazuhiko; Arita, Kazunori; Kurisu, Kaoru

doi:10.2176/nmc.ra.2017-0011

Cited by 32 publications

(18 citation statements)

References 83 publications

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“… 21) Another study showed that both 1-year and 5-year mortality rates were comparable with those for unselected cohorts and emphasized the importance of assessment of preoperative performance status and comorbidities, especially for elderly patients. 22) Combined with our results, we believe that mortality in elderly patients would be similar to that in younger patients or in at least age-matched controls if the indications for surgery are adequately considered.…”

Section: Discussionsupporting

confidence: 77%

Nation-wide Brain Tumor Registry-based Study of Intracranial Meningioma in Japan: Analysis of Surgery-related Risks

Oya

Ikawa

Ichihara

et al. 2021

Neurol. Med. Chir.(Tokyo)

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Although surgical resection is the most preferred treatment for intracranial meningiomas, a detailed analysis of the surgery-related risks based on large population data has not been conducted to date. In this study, we analyzed the nation-wide brain tumor registry to assess the surgical risk factors for intracranial meningiomas to provide information for an optimal treatment strategy. Data of 4081 meningioma patients who underwent initial resection between 2001 and 2008 were extracted from the Brain Tumor Registry of Japan (BTRJ) database and reviewed for postoperative mortality, aggravation of Karnofsky Performance Score (KPS), and complications. The total in-hospital mortality rate was 0.59%. Male sex and tumor size ≥30 mm were independent risk factors for mortality. Among 4081 cases, 4.4% of patients had KPS that were lowered by 20 or more points at the time of discharge after surgery. Age ≥65 years, higher WHO grading, tumor location at the skull base, tumor size ≥30 mm, and non-gross total resections were associated with lowering of KPS scores by 20 or more points. The overall incidence of surgical complications was 19.3%. The rate of occurrence of new postoperative seizure in patients with supratentorial meningioma was 10.9%. All complications except for vascular complications occurred with significantly lower frequencies in asymptomatic patients than in symptomatic patients. Our results provide useful information regarding the surgical risks when surgical intervention is being considered for intracranial meningiomas. Surgery is an important option for asymptomatic meningiomas as the mortality rate and complication rate in the current study were sufficiently low.

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Section: Discussionsupporting

confidence: 77%

Nation-wide Brain Tumor Registry-based Study of Intracranial Meningioma in Japan: Analysis of Surgery-related Risks

Oya

Ikawa

Ichihara

et al. 2021

Neurol. Med. Chir.(Tokyo)

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“…These rates were similar to those observed in previous studies; the rates of mortality and complications after surgery were reported as 0.5-1.5%, and 6.8-14.8% respectively [5,8,15,27]. A recent systematic review reported that in elderly patients with meningiomas, the rate of one-year postoperative mortality and neurological complications after surgery ranged from 2.7-49.4% and from 0-16.7%, respectively [9]. mFI scores and age as predictors of surgical complications and worsening…”

Section: Discussionsupporting

confidence: 89%

“…However, we found no signi cant association between advanced age and in-hospital mortality. According to a recent systematic review of elderly patients with meningioma surgery, the rate of in-hospital mortality, worsening of the postoperative performance status, neurological de cits, and general complications ranged widely based on the reports and were not necessarily associated with advanced-age [9].…”

Section: Discussionmentioning

confidence: 99%

The 5-Factor Modified Frailty Index Predicts Complications and Worsening After Meningioma Surgery in Non-elderly Rather Than Elderly Patients: A Nationwide Registry Study

Ikawa

Michihata

Oya

et al. 2021

Preprint

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The simplified 5-factor modified frailty index (mFI-5) is a useful indicator of outcome for patients undergoing surgeries and considered as an important risk factor in elderly patients. However, its usefulness has not been validated based on age groups. We aimed to investigate the risk factors including the mFI-5 across age groups for complications and worse outcomes in meningioma surgery using data obtained from the nationwide database in Japan. We extracted data from the nationwide registry database in Japan between 2010 and 2015. Age (< 65, 65–74, and ≥ 75 years), sex, Barthel Index (BI), mFI-5 scores, and complications were evaluated. Multivariate logistic regression analyses identified risk factors across all age groups for worsening BI scores and complications after surgery. In 8,138 included cases, an mFI-5 score ≥ 2 items was a significant risk factor for worsening BI scores in patients aged < 65 years (odds ratio: 2.00; 95% confidence interval: 1.31-3.06), but not in patients aged 65-74 years and those aged ≥ 75 years. Similar results were noted for complications in patients aged < 65 years (2.40; 1.67–3.44), but not in patients aged 65-74 years and those aged ≥ 75 years. In conclusion, the mFI-5 scores can predict the risk of worsening outcome and complications in non-elderly patients aged < 65 years rather than in elderly patients aged ≥ 65 years. In meningioma surgeries, care must be taken when making decisions using the mFI-5 scores based on the patients’ age.Trial RegistrationName: Study on treatment method, age group, complications, and outcome of meningiomas and hemangioblastomas using DPC, URL: http://www.umin.ac.jp/ctr/index-j.htmID: UMIN000038486, No.: R000043856

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“…[ 16 , 18 , 19 ] Similarly, age has been correlated with poorer outcomes in meningiomas in the absence of careful consideration of preoperative medical risk factors that may disproportionally affect older patient populations. [ 6 , 9 , 11 , 13 , 21 , 23 , 29 ] Several case series have reported age as an important prognostic factor for infratentorial tumor outcomes. [ 1 , 3 , 23 ] This literature highlights the importance of considering medical comorbidities, age, tumor location, and surgical approach when treating older infratentorial tumor patients.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of infratentorial cranial surgery for tumor resection in older patients: An analysis of the National Surgical Quality Improvement Program

Perla

Pertsch

Leary

et al. 2021

Surgical Neurology International

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Background: Poorer outcomes for infratentorial tumor resection have been reported. There is a lack of large multicenter analyses describing infratentorial surgery outcomes in older patients. We characterized outcomes in patients aged ≥65 years undergoing infratentorial cranial surgery. Methods: The National Surgical Quality Improvement Project database was queried from 2012 to 2018 for patients ≥18 years undergoing elective infratentorial cranial surgery for tumor resection. Patients were grouped into 65–74 years, ≥75 years, and 18–64 years cohorts. Multivariable regressions compared outcome measures. Results: Of 2212 patients, 28.3% were ≥65 years, of whom 24.8% were ≥75 years. Both older subpopulations had worse American Society of Anesthesiologists classification compared to controls (P < 0.01) and more comorbidities. Patients 65–74 and ≥75 years had higher rates of major complication (adjusted odds ratio [aOR] = 1.77, 95% CI = 1.13–2.79 and aOR = 3.44, 95% CI = 1.96–6.02, respectively), prolonged length of stay (LOS) (aOR = 1.89, 95% CI = 1.15–3.12 and aOR = 3.00, 95% CI = 1.65–5.44, respectively), and were more likely to be discharged to a location other than home (aOR = 2.43, 95% CI =1.73–3.4 and aOR = 3.41, 95% CI = 2.18–5.33, respectively) relative to controls. Patients ≥75 had higher rates of readmission (aOR = 1.86, 95% CI = 1.13–3.08) and mortality (aOR = 3.28, 95% CI = 1.21–8.89) at 30 days. Conclusion: Patients ≥65 years experienced more complications, prolonged LOS, and were less often discharged home than adults <65 years. Patients ≥75 years had higher rates of 30-day readmission and mortality. There is a need for careful preoperative optimization in older patients undergoing infratentorial tumor cranial surgery.

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Review of Current Evidence Regarding Surgery in Elderly Patients with Meningioma

Cited by 32 publications

References 83 publications

Nation-wide Brain Tumor Registry-based Study of Intracranial Meningioma in Japan: Analysis of Surgery-related Risks

Nation-wide Brain Tumor Registry-based Study of Intracranial Meningioma in Japan: Analysis of Surgery-related Risks

The 5-Factor Modified Frailty Index Predicts Complications and Worsening After Meningioma Surgery in Non-elderly Rather Than Elderly Patients: A Nationwide Registry Study

Outcomes of infratentorial cranial surgery for tumor resection in older patients: An analysis of the National Surgical Quality Improvement Program

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