Repeated craniotomies for intracranial tumors: is the risk increased? Pooled analysis of two prospective, institutional registries of complications and outcomes

Costanza Maria Zattra, David Y. Zhang, Morgan Broggi, Julia Velz, Flavio Vasella, Dominik Seggewiss, Silvia Schiavolin, Oliver Bozinov, Niklaus Krayenbühl, Johannes Sarnthein, Paolo Ferroli, Luca Regli, Martin N. Stienen

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: Deciding whether to re-operate patients with intracranial tumor recurrence or remnant is challenging, as the data on safety of repeated procedures is limited. This study set out to evaluate the risks for morbidity, mortality, and complications after repeated operations, and to compare those to primary operations. Methods: Retrospective observational two-center study on consecutive patients undergoing microsurgical tumor resection. The data derived from independent, prospective institutional registries. The primary endpoint was morbidity at 3 months (M3), defined as significant decrease on the Karnofsky Performance Scale (KPS). Secondary endpoints were mortality, rate and severity of complications according to the Clavien–Dindo Grade (CDG). Results: 463/2403 (19.3%) were repeated procedures. Morbidity at M3 occurred in n = 290 patients (12.1%). In univariable analysis, patients undergoing repeated surgery were 98% as likely as patients undergoing primary surgery to experience morbidity (OR 0.98, 95% CI 0.72–1.34, p = 0.889). In multivariable analysis adjusted for age, sex, tumor size, histology and posterior fossa location, the relationship remained stable (aOR 1.25, 95% CI 0.90–1.73, p = 0.186). Mortality was n = 10 (0.4%) at discharge and n = 95 (4.0%) at M3, without group differences. At least one complication occurred in n = 855, and the rate (35.5% vs. 35.9%, p = 0.892) and severity (CDG; p = 0.520) was similar after primary and repeated procedures. Results were reproduced in subgroup analyses for meningiomas, gliomas and cerebral metastases. Conclusions: Repeated surgery for intracranial tumors does not increase the risk of morbidity. Mortality, and both the rate and severity of complications are comparable to primary operations. This information is of value for patient counseling and the informed consent process.

Original languageEnglish
JournalJournal of Neuro-Oncology
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Craniotomy
Registries
Morbidity
Neoplasms
Mortality
Karnofsky Performance Status
Meningioma
Informed Consent
Glioma
Counseling
Histology
Neoplasm Metastasis
Safety
Recurrence

Keywords

  • Brain tumor
  • Complications
  • Craniotomy
  • Morbidity
  • Mortality
  • Reoperation

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

Cite this

Repeated craniotomies for intracranial tumors : is the risk increased? Pooled analysis of two prospective, institutional registries of complications and outcomes. / Zattra, Costanza Maria; Zhang, David Y.; Broggi, Morgan; Velz, Julia; Vasella, Flavio; Seggewiss, Dominik; Schiavolin, Silvia; Bozinov, Oliver; Krayenbühl, Niklaus; Sarnthein, Johannes; Ferroli, Paolo; Regli, Luca; Stienen, Martin N.

In: Journal of Neuro-Oncology, 01.01.2018.

Research output: Contribution to journalArticle

Zattra, Costanza Maria ; Zhang, David Y. ; Broggi, Morgan ; Velz, Julia ; Vasella, Flavio ; Seggewiss, Dominik ; Schiavolin, Silvia ; Bozinov, Oliver ; Krayenbühl, Niklaus ; Sarnthein, Johannes ; Ferroli, Paolo ; Regli, Luca ; Stienen, Martin N. / Repeated craniotomies for intracranial tumors : is the risk increased? Pooled analysis of two prospective, institutional registries of complications and outcomes. In: Journal of Neuro-Oncology. 2018.
@article{9395eda66a514b4ebe3e8d92598d0ae1,
title = "Repeated craniotomies for intracranial tumors: is the risk increased? Pooled analysis of two prospective, institutional registries of complications and outcomes",
abstract = "Purpose: Deciding whether to re-operate patients with intracranial tumor recurrence or remnant is challenging, as the data on safety of repeated procedures is limited. This study set out to evaluate the risks for morbidity, mortality, and complications after repeated operations, and to compare those to primary operations. Methods: Retrospective observational two-center study on consecutive patients undergoing microsurgical tumor resection. The data derived from independent, prospective institutional registries. The primary endpoint was morbidity at 3 months (M3), defined as significant decrease on the Karnofsky Performance Scale (KPS). Secondary endpoints were mortality, rate and severity of complications according to the Clavien–Dindo Grade (CDG). Results: 463/2403 (19.3{\%}) were repeated procedures. Morbidity at M3 occurred in n = 290 patients (12.1{\%}). In univariable analysis, patients undergoing repeated surgery were 98{\%} as likely as patients undergoing primary surgery to experience morbidity (OR 0.98, 95{\%} CI 0.72–1.34, p = 0.889). In multivariable analysis adjusted for age, sex, tumor size, histology and posterior fossa location, the relationship remained stable (aOR 1.25, 95{\%} CI 0.90–1.73, p = 0.186). Mortality was n = 10 (0.4{\%}) at discharge and n = 95 (4.0{\%}) at M3, without group differences. At least one complication occurred in n = 855, and the rate (35.5{\%} vs. 35.9{\%}, p = 0.892) and severity (CDG; p = 0.520) was similar after primary and repeated procedures. Results were reproduced in subgroup analyses for meningiomas, gliomas and cerebral metastases. Conclusions: Repeated surgery for intracranial tumors does not increase the risk of morbidity. Mortality, and both the rate and severity of complications are comparable to primary operations. This information is of value for patient counseling and the informed consent process.",
keywords = "Brain tumor, Complications, Craniotomy, Morbidity, Mortality, Reoperation",
author = "Zattra, {Costanza Maria} and Zhang, {David Y.} and Morgan Broggi and Julia Velz and Flavio Vasella and Dominik Seggewiss and Silvia Schiavolin and Oliver Bozinov and Niklaus Krayenb{\"u}hl and Johannes Sarnthein and Paolo Ferroli and Luca Regli and Stienen, {Martin N.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s11060-018-03058-y",
language = "English",
journal = "Journal of Neuro-Oncology",
issn = "0167-594X",
publisher = "Springer New York LLC",

}

TY - JOUR

T1 - Repeated craniotomies for intracranial tumors

T2 - is the risk increased? Pooled analysis of two prospective, institutional registries of complications and outcomes

AU - Zattra, Costanza Maria

AU - Zhang, David Y.

AU - Broggi, Morgan

AU - Velz, Julia

AU - Vasella, Flavio

AU - Seggewiss, Dominik

AU - Schiavolin, Silvia

AU - Bozinov, Oliver

AU - Krayenbühl, Niklaus

AU - Sarnthein, Johannes

AU - Ferroli, Paolo

AU - Regli, Luca

AU - Stienen, Martin N.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Purpose: Deciding whether to re-operate patients with intracranial tumor recurrence or remnant is challenging, as the data on safety of repeated procedures is limited. This study set out to evaluate the risks for morbidity, mortality, and complications after repeated operations, and to compare those to primary operations. Methods: Retrospective observational two-center study on consecutive patients undergoing microsurgical tumor resection. The data derived from independent, prospective institutional registries. The primary endpoint was morbidity at 3 months (M3), defined as significant decrease on the Karnofsky Performance Scale (KPS). Secondary endpoints were mortality, rate and severity of complications according to the Clavien–Dindo Grade (CDG). Results: 463/2403 (19.3%) were repeated procedures. Morbidity at M3 occurred in n = 290 patients (12.1%). In univariable analysis, patients undergoing repeated surgery were 98% as likely as patients undergoing primary surgery to experience morbidity (OR 0.98, 95% CI 0.72–1.34, p = 0.889). In multivariable analysis adjusted for age, sex, tumor size, histology and posterior fossa location, the relationship remained stable (aOR 1.25, 95% CI 0.90–1.73, p = 0.186). Mortality was n = 10 (0.4%) at discharge and n = 95 (4.0%) at M3, without group differences. At least one complication occurred in n = 855, and the rate (35.5% vs. 35.9%, p = 0.892) and severity (CDG; p = 0.520) was similar after primary and repeated procedures. Results were reproduced in subgroup analyses for meningiomas, gliomas and cerebral metastases. Conclusions: Repeated surgery for intracranial tumors does not increase the risk of morbidity. Mortality, and both the rate and severity of complications are comparable to primary operations. This information is of value for patient counseling and the informed consent process.

AB - Purpose: Deciding whether to re-operate patients with intracranial tumor recurrence or remnant is challenging, as the data on safety of repeated procedures is limited. This study set out to evaluate the risks for morbidity, mortality, and complications after repeated operations, and to compare those to primary operations. Methods: Retrospective observational two-center study on consecutive patients undergoing microsurgical tumor resection. The data derived from independent, prospective institutional registries. The primary endpoint was morbidity at 3 months (M3), defined as significant decrease on the Karnofsky Performance Scale (KPS). Secondary endpoints were mortality, rate and severity of complications according to the Clavien–Dindo Grade (CDG). Results: 463/2403 (19.3%) were repeated procedures. Morbidity at M3 occurred in n = 290 patients (12.1%). In univariable analysis, patients undergoing repeated surgery were 98% as likely as patients undergoing primary surgery to experience morbidity (OR 0.98, 95% CI 0.72–1.34, p = 0.889). In multivariable analysis adjusted for age, sex, tumor size, histology and posterior fossa location, the relationship remained stable (aOR 1.25, 95% CI 0.90–1.73, p = 0.186). Mortality was n = 10 (0.4%) at discharge and n = 95 (4.0%) at M3, without group differences. At least one complication occurred in n = 855, and the rate (35.5% vs. 35.9%, p = 0.892) and severity (CDG; p = 0.520) was similar after primary and repeated procedures. Results were reproduced in subgroup analyses for meningiomas, gliomas and cerebral metastases. Conclusions: Repeated surgery for intracranial tumors does not increase the risk of morbidity. Mortality, and both the rate and severity of complications are comparable to primary operations. This information is of value for patient counseling and the informed consent process.

KW - Brain tumor

KW - Complications

KW - Craniotomy

KW - Morbidity

KW - Mortality

KW - Reoperation

UR - http://www.scopus.com/inward/record.url?scp=85057564355&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85057564355&partnerID=8YFLogxK

U2 - 10.1007/s11060-018-03058-y

DO - 10.1007/s11060-018-03058-y

M3 - Article

AN - SCOPUS:85057564355

JO - Journal of Neuro-Oncology

JF - Journal of Neuro-Oncology

SN - 0167-594X

ER -