Efficacy Assessment of Supramarginal Resection Versus Gross Total Resection in Glioblastoma: A Systematic Literature...

The standard treatment for glioblastoma multiforme (GBM) typically involves a surgical resection followed by radiation therapy and chemotherapy. The extent of resection (EOR) plays a significant role in predicting the prognosis of GBM. The literature showed improved survival outcomes with greater removal of contrast-enhancing tumor mass. We aim to compare the effects of supramarginal resection and gross total resection for the management of GBM.

A systematic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to February 10, 2024. All statistical analyses were conducted in Review Manager 5.4.1. Twelve studies meeting the inclusion criteria were selected. A random-effects model was used when heterogeneity was observed to pool the studies, and the results were reported as hazard ratio (HR), odds ratio (OR), and standard mean difference (SMD), along with their respective 95% confidence intervals (CI). Primary outcomes were overall survival, Karnofsky Performance Status, and age; secondary outcomes included median progression-free survival, mortality, and tumor recurrence.

Supramarginal resection was associated with improved overall survival compared with gross total resection (HR = 0.90, 95% CI 0.84-0.97; p = 0.005; I² = 96%), and increasing age was associated with decreased survival (HR = 1.03, 95% CI 1.00-1.05; p = 0.02; I² = 0%). No statistically significant association was observed between lower Karnofsky Performance Status and survival (HR = 0.77, 95% CI 0.53-1.12; p = 0.18; I² = 74%).

Supramarginal resection of GBM yielded more favorable results than gross total resection, with minimal difference between adverse effects.