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Complete Versus Incomplete Surgical Resection in Intramedullary Ependymomas: A Systematic Review and Meta-analysis

Salari, Farhad; Golpayegani, Mehdi; Sadeghi-Naini, Mohsen; Hanaei, Sara; Shokraneh, Farhad; Ahmadi, Ayat; Khayat-kashani, Hamid Reza; ... Rahimi-Movaghar, Vafa; + view all (2020) Complete Versus Incomplete Surgical Resection in Intramedullary Ependymomas: A Systematic Review and Meta-analysis. Global Spine Journal , 11 (5) pp. 761-773. 10.1177/2192568220939523. Green open access

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Abstract

Study Design: Systematic review. Objective: To compare outcomes of complete versus incomplete resection in primary intramedullary spinal cord ependymoma. Methods: A comprehensive search of the MEDLINE, CENTRAL, and Embase databases was conducted by 2 independent investigators. Random-effect meta-analysis and meta-regression with seven covariates were performed to evaluate the reason for the heterogeneity among studies. We also used individual patient data in the integrative analysis to compare complete and incomplete resection based on 4 outcomes: progression-free survival (PFS), overall survival (OS), postoperative neurological improvement (PNI), and follow-up neurological improvement (FNI). Results: A total of 23 studies were identified, including 407 cases. Significant heterogeneity among included studies was observed in risk estimates (I2 for PFS, FNI, and PNI were 49.5%, 78.3%, and 87.2%, respectively). The mean follow-up time across cases was 48.6 ± 2.35 months. Cox proportional multivariable analysis revealed that the complete resection can prolong PFS (model, hazard ratio = 0.18, CI 0.05-0.54, P =.004,) and improve the FNI (binary logistic regression, adjusted odds ratio = 16.5, CI 1.6-171, P =.019). However, PNI and OS were similar in patients with incomplete resected spinal cord ependymoma compared with complete resection (binary logistic regression respectively and Cox multivariable analysis, P >.5). Conclusion: The data presented in this study showed that OS was not significantly affected by the degree of surgery. However, complete resection of intramedullary ependymomas provides the optimal outcomes with longer PFS and better long-term neurological outcomes than incomplete resection.

Type: Article
Title: Complete Versus Incomplete Surgical Resection in Intramedullary Ependymomas: A Systematic Review and Meta-analysis
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/2192568220939523
Publisher version: https://doi.org/10.1177/2192568220939523
Language: English
Additional information: © The Author(s) 2020. Creative Commons License (CC BY-NC-ND 4.0) This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
Keywords: Science & Technology, Life Sciences & Biomedicine, Clinical Neurology, Orthopedics, Neurosciences & Neurology, tumor, intramedullary tumor, ependymoma, overall survival, SPINAL-CORD EPENDYMOMAS, MICROSURGICAL TREATMENT, MYXOPAPILLARY EPENDYMOMAS, PROGNOSTIC-FACTORS, CLINICAL-FEATURES, CAUDA-EQUINA, OUTCOMES, TUMORS, SERIES, MANAGEMENT
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10179699
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