Extent of Resection of Epidermoid Tumors Affects Risk of Recurrence:Results of The Largest Meta-Analysis of 691 Patients
Yawei Zhang, Zeynep Erson-Omay, Wyatt David, Elena Fomchenko, Lan Jin, Brian Shear, Robert Fulbright, Anita Huttner, Jennifer Moliterno
Introduction: Neurosurgical resection of epidermoid tumors can be challenging and potentially morbid, leading to questions surrounding extent of resection.
Objective: We performed the largest meta-analysis of patients with epidermoid tumors to compare recurrence rates for STR and GTR and associated complications.
Methods: A systemic literature review using PRISMA guidelines was completed followed by a proportional meta-analysis to compare the pooled recurrence rates between STR and GTR in epidermoid tumors. Fixed- and mixed-effect models were used and the relationship between recurrence rate and follow-up time was studied using linear regression.
Results: Twenty-seven studies with 691 patients met our inclusion criteria, among whom, 293 (42%) underwent STR, while 398 (58%) received GTR. The average recurrence rate of all procedures was 11%. The proportional meta-analysis showed that the pooled recurrence rate after STR (21%) was 7 times that after GTR (3%). The most common surgical complications were transient cranial nerve palsies, occurring equally in STR and GTR cases when reported. The average recurrence rate for studies with longer follow-up time (> 4.4 years) (17.4%) was significantly higher than shorter follow-up time (< 4.4 years) (5.7%).
Conclusions: STR of epidermoid tumors is associated with a significantly higher rate of recurrence (~ 7 times) compared to GTR and correlates with time such that more recurrences, on average, are observed after longer post-operative periods. Types of complications, and their frequencies, do not seem to differ between STR and GTR. Attempts at GTR, including capsule removal when appropriate, should be made during the initial surgery with efforts to optimize success. Close post-operative follow-up is recommended.