• Chad A Glenn, Cordell M Baker, Andrew K Conner, Josh D Burks, Phillip A Bonney, Robert G Briggs, Adam D Smitherman, James D Battiste, and Michael E Sughrue.
• Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
• World Neurosurg. 2018 Jun 1; 114: e747-e755.

BackgroundResection of the T1 contrast-enhancing portion of glioblastoma multiforme (GBM) has been shown to increase patient survival, although whether GBM resection beyond these boundaries has an additional survival benefit is not clear. In this study, we examined the effect of resecting the enhancement and a margin of brain tissue surrounding the enhancement in patients with GBM of the temporal lobe.MethodsWe identified 32 consecutive patients with temporal lobe GBM who underwent initial resection between 2012 and 2015. Progression-free survival (PFS) and overall survival (OS) were analyzed based on the following categories: subtotal resection (STR; <99% of contrast enhancement removed), gross total resection (GTR; 100% of T1 contrast enhancement removed), and supramaximal resection (SMR; removal of T1 contrast enhancement plus removal of at least 1 cm of brain tissue surrounding the enhancement).ResultsPatients undergoing SMR demonstrated a substantially improved median PFS (15 months) compared with those undergoing GTR (7 months) or those undergoing STR (6 months) (P < 0.003). A median OS advantage was also present in the SMR group (24 months) compared with the GTR (11 months) and STR (9 months) groups (P < 0.004). SMR significantly improved PFS (hazard ratio [HR], 0.093; 95% confidence interval [CI], 0.01-0.89; P = 0.039) and OS (HR, 0.169; 95% CI, 0.05-0.57; P < 0.004) when controlling for other variables. The complication rates did not differ among the resection groups (P = 0.66).ConclusionsAchieving SMR substantially improved survival in patients with temporal lobe GBM compared with GTR of the enhancement alone.Copyright © 2018. Published by Elsevier Inc.

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