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    Complete versus incomplete surgical resection in intramedullary ependymomas: A systematic review and meta-analysis

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    Author
    Shokraneh, Farhad
    Keyword
    Spinal cord injuries
    General surgery
    Date
    2020
    
    Metadata
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    DOI
    10.1177/2192568220939523
    Publisher's URL
    https://journals.sagepub.com/doi/10.1177/2192568220939523
    Abstract
    STUDY DESIGNSystematic review.OBJECTIVETo compare outcomes of complete versus incomplete resection in primary intramedullary spinal cord ependymoma.METHODSA comprehensive search of the MEDLINE, CENTRAL, and Embase databases was conducted by 2 independent investigators. Random-effect meta-analysis and meta-regression with seven covariates were performed to evaluate the reason for the heterogeneity among studies. We also used individual patient data in the integrative analysis to compare complete and incomplete resection based on 4 outcomes: progression-free survival (PFS), overall survival (OS), postoperative neurological improvement (PNI), and follow-up neurological improvement (FNI).RESULTSA total of 23 studies were identified, including 407 cases. Significant heterogeneity among included studies was observed in risk estimates (I2 for PFS, FNI, and PNI were 49.5%, 78.3%, and 87.2%, respectively). The mean follow-up time across cases was 48.6 ± 2.35 months. Cox proportional multivariable analysis revealed that the complete resection can prolong PFS (model, hazard ratio = 0.18, CI 0.05-0.54, P = .004,) and improve the FNI (binary logistic regression, adjusted odds ratio = 16.5, CI 1.6-171, P = .019). However, PNI and OS were similar in patients with incomplete resected spinal cord ependymoma compared with complete resection (binary logistic regression respectively and Cox multivariable analysis, P > .5).CONCLUSIONThe data presented in this study showed that OS was not significantly affected by the degree of surgery. However, complete resection of intramedullary ependymomas provides the optimal outcomes with longer PFS and better long-term neurological outcomes than incomplete resection.
    Citation
    Salari, F., Golpayegani, M., Sadeghi-Naini, M., Hanaei, S., Shokraneh, F., Ahmadi, A., Khayat-Kashani, H. R., Vacarro, A. R. & Rahimi-Movaghar, V. (2020). Complete versus incomplete surgical resection in intramedullary ependymomas: A systematic review and meta-analysis. Global Spine Journal, 11(5), pp. 761-773.
    Type
    Article
    URI
    http://hdl.handle.net/20.500.12904/5035
    Collections
    Surgical Care

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