The relationship between survival and the extent of the resection in patients with supratentorial malignant gliomas.

Current neurosurgical opinion favors the radical surgical removal of supratentorial gliomas, when feasible, in the belief that this optimizes patient survival. Although bolstered by the results of some early investigators, the efficacy of this approach remains debatable. Therefore, we undertook a review of the English language literature of the past 30 years for a series of surgically treated malignant gliomas. Twenty reports comprising 5691 patients were identified. Only 4 found the extent of the surgical resection related to survival. In 2 of these, it followed age, histological findings, and performance status in importance. The 2 other studies did not rank the prognostic variables at all. On closer inspection, however, there does appear to be a subgroup of young patients with favorable histological findings and good performance status for whom surgery is beneficial. Future reporting of surgical results of patients with gliomas will require stratification by the known prognostic variables of age, histological findings, and performance status to characterize better this subgroup for whom surgery is beneficial.