The role of lobectomy in glioblastoma management: A systematic review and meta-analysis

Abstract

Introduction: Lobectomy has recently been employed in the management of glioblastoma (GB). Compared to subtotal, gross total and supramarginal resection, lobectomy provides maximum cytoreduction and improves overall survival (OS). Research question: The primary aim of this study is to compare lobectomy to other techniques for managing GB in terms of OS and progression-free survival (PFS). This study evaluated the association of the available surgical techniques for GB management with the reported relevant seizure outcome, operation time, length of stay, complication incidence, and Karnofsky performance status. Materials and methods: A PRISMA-compliant systematic review and meta-analysis was performed. We searched PubMed, Scopus, and Web of Science from January 2013 until April 2023. Random-effects models were employed. The Newcastle-Ottawa scale (NOS) and the GRADE approach were used for estimating risk of bias and quality of evidence. Results: We included six studies. Lobectomy demonstrated a mean OS of 25 months, compared to 13.72 months for gross total resection (GTR), and a PFS of 16.13 months, compared to 8.77 months for GTR. Comparing lobectomy to GTR, no statistically significant differences were observed regarding seizure management, length of stay, operation time, complications, and KPS due to limited amount of data. Discussion and conclusion: Our analysis demonstrated that lobectomy compared to GTR has a tremendous impact on the OS and the PFS, which seems to be improved almost by a year. Lobectomy, while demanding from a technical standpoint, constitutes a safe surgical procedure but further studies should assess its exact role in the management of GB patients.

Keywords

• Glioblastoma
• Gross total resection
• Lobectomy
• Meta-analysis
• Overall survival
• Progression-free survival