The Role of Surgery in Recurrent Glioblastoma Multiforme: A Retrospective Study

Background: Of all glial tumors, glioblastoma (GBM) is the most malignant. They represent around 54% of all gliomas and 16% of primary brain tumors. They have a very poor prog-nosis and extraordinarily high recurrence rates. The role of sur-gery after recurrence is still controversial to this day. Aim of Study: This study aims to clarify the importance of surgery in the management of recurrent GBM. Patients and Methods: This was a retrospective study done on 47 patients that were dichotomized into 2 groups. 27 patients were in the single resection group (SRG). 20 patients were in the multiple resection group (MRG). The patients were com-pared together through their overall survival (OS). Other pos-sible prognostic factors such as the extent of resection (EOR) and age were also analyzed. Results: Patients in the MRG experienced significantly better survival over those in the SRG (median OS 36 vs. 11 months respectively p=0.01). Other factors also affected the overall survival. Complications after the first surgery decreased survival in patients to a median OS of 9 months as opposed to patients who didn’t experience complications with a median OS of 24 months (p<0.001). Both pre and postoperative per-formance status affected the OS of patients (p<0.0001). EOR also had an impact on OS. Patients who were operated upon by subtotal resection had worse outcomes when compared with those operated upon by gross total resection (median OS 9 vs. 24 months respectively p=0.026). Conclusion: Surgery increases survival in recurrent GBM, as well as other factors such as age, performance status, EOR, and postoperative complication. Performance status, however, was found to be the main prognostic indicator of survival in these patients (p<0.001). Gender, tumor site, tumor extension, and clinical presentation do not appear to have any effect on survival.