• Bayard Wilson, Crina M Peterson, Hua Wei, Mao Ying, Jiri Bartek, and Clark C Chen.
• Department of Neurosurgery, University of California, Los Angeles, California, USA.
• World Neurosurg. 2024 Oct 1; 190: e249e255e249-e255.

ObjectiveHow maximal safe resection of glioblastoma (GBM) is implemented in the clinical setting remains understudied. Here, we utilized a survey-based approach to understand physician perspectives on this matter.MethodsScenarios involving GBMs were presented to physicians who were asked to select from planned subtotal resection, gross total resection (GTR), medical therapy only, or palliative care. Demographic, experience, and Likert scales of value assessment were collected.ResultsIn the scenario involving a corpus callosum GBM, 2.33% opted for GTR. For a right frontal GBM, 91.7% opted for GTR. In contrast, only 30.8% chose GTR of a right motor strip GBM (P < 0.001). When presented with a left motor strip GBM, fewer respondents (12.7%, P < 0.001) opted for GTR. Physicians who placed a high value on preserving physical independence were more likely to forgo GTR for right motor GBMs (hazard ratio = 0.068, 95% confidence interval: 0.47-0.97, P = 0.035), and physicians who placed a high value on their faith were more likely to opt for surgical treatments that differ from the general consensus, for instance opting for GTR of the corpus callosum GBM (hazard ratio = 4.18, 95% confidence interval: 1.63-10.74, P = 0.003). No other associations were found between the choice for GTR and other variables collected.ConclusionsOur results suggest that while maximal safe resection remains a guiding principle for GBM resection, physician preference in terms of the extent of resection varies significantly as a function of tumor location and personal values.Copyright © 2024. Published by Elsevier Inc.

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