SynthesisNeuro-oncology2015
Biopsy versus partial versus gross total resection in older patients with high-grade glioma: a systematic review and meta-analysis.
Abstract readMeta-AnalysisSystematic Review
In one paragraph
Synthesis in Neuro-oncology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 97 papers, 8 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
97citing papers in PubMed, 8 pooled it
–field-weighted citation impact
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
97 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- Comparative efficacy of glioma treatment strategies: an umbrella review of meta-analyses.Annals of medicine · 2025Pooled it
- Prognostic value of surgical resection over biopsy in elderly patients with glioblastoma: a meta-analysis.Journal of neuro-oncology · 2024Pooled it
- Surgical management of Glioma Grade 4: technical update from the neuro-oncology section of the Italian Society of Neurosurgery (SINch®): a systematic review.Journal of neuro-oncology · 2023Pooled it
- Extent of Tumor Resection and Survival in Pediatric Patients With High-Grade Gliomas: A Systematic Review and Meta-analysis.JAMA network open · 2022Pooled it
- Pooled it
- Navigated Transcranial Magnetic Stimulation Motor Mapping Usefulness in the Surgical Management of Patients Affected by Brain Tumors in Eloquent Areas: A Systematic Review and Meta-Analysis.Frontiers in neurology · 2021Pooled it
- Gross Total vs. Subtotal Resection on Survival Outcomes in Elderly Patients With High-Grade Glioma: A Systematic Review and Meta-Analysis.Frontiers in oncology · 2020Pooled it
- Management of elderly patients with glioblastoma-multiforme-a systematic review.The British journal of radiology · 2018Pooled it
- [Frequent neurosurgically treatable diseases in geriatric patients].Zeitschrift fur Gerontologie und Geriatrie · 2026Article
- Optimizing the Stupp protocol for treatment of glioblastoma: eliminating age bias, enhancing treatment timing, use of stereotactically-guided sequential boost, and dexamethasone dosing.Journal of neuro-oncology · 2026Article
- Post-Treatment MRI Features on First Follow-Up Imaging in Diffuse Gliomas After Near-Total Resection: A Real-World Exploratory Cohort Study.Medicina (Kaunas, Lithuania) · 2026Article
- Endoscopic Transorbital Approach for Select Recurrent and Newly Diagnosed Anteromedial Temporal Lobe Gliomas.Journal of neurological surgery. Part B, Skull base · 2026Article
- Predictors of Survival in Patients Aged ≥70 with Glioblastoma: A Time-Dependent Multivariable Analysis.Cancers · 2026Article
- Neurosurgical and neuro-oncological outcomes of confirmatory brain biopsies in patients with glioblastoma: a real-life monocentric experience.Brain & spine · 2026Article
- Survival prediction in glioblastoma: 10-year follow-up from the Dutch Neurosurgery Quality Registry.Journal of neuro-oncology · 2025Article
- Do the benefits of IDH mutations in high-grade glioma persist beyond the first recurrence? A multi-institutional retrospective analysis.Journal of neuro-oncology · 2025Article
- Practical and statistical aspects of subgroup analyses in surgical neuro-oncology: A comprehensive review from the PIONEER consortium.Neuro-oncology · 2025Review
- Construction and validation of a prognostic nomogram model integrating machine learning-pathomics and clinical features in IDH-wildtype glioblastoma.Journal of translational medicine · 2025Article
- Frequency and outcomes of midline gliomas in a tertiary care hospital in Pakistan: a retrospective study.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2025Article
- MRI-based deep learning with clinical and imaging features to differentiate medulloblastoma and ependymoma in children.Frontiers in molecular biosciences · 2025Article
37 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
16 authors.
Saleh A AlmenawerDivision of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).
Jetan H BadhiwalaDivision of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).
Waleed AlhazzaniDivision of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).
Jeffrey GreenspoonDivision of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).
Forough FarrokhyarDivision of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).
Blake YarascavitchDivision of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).
Almunder AlgirdDivision of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).
Edward KachurDivision of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).
Aleksa CenicDivision of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).
Waseem SharieffDivision of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).
Paula KlurfanDivision of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).
Thorsteinn GunnarssonDivision of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).
Olufemi AjaniDivision of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).
Kesava ReddyDivision of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).
Sheila K SinghDivision of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).
Naresh K MurtyDivision of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOptimal extent of surgical resection (EOR) of high-grade gliomas (HGGs) remains uncertain in the elderly given the unclear benefits and potentially higher rates of mortality and morbidity associated with more extensive degrees of resection.
methodsWe undertook a meta-analysis according to a predefined protocol and systematically searched literature databases for reports about HGG EOR. Elderly patients (≥60 y) undergoing biopsy, subtotal resection (STR), and gross total resection (GTR) were compared for the outcome measures of overall survival (OS), postoperative karnofsky performance status (KPS), progression-free survival (PFS), mortality, and morbidity. Treatment effects as pooled estimates, mean differences (MDs), or risk ratios (RRs) with corresponding 95% confidence intervals (CIs) were determined using random effects modeling.
resultsA total of 12 607 participants from 34 studies met eligibility criteria, including our current cohort of 211 patients. When comparing overall resection (of any extent) with biopsy, in favor of the resection group were OS (MD 3.88 mo, 95% CI: 2.14-5.62, P < .001), postoperative KPS (MD 10.4, 95% CI: 6.58-14.22, P < .001), PFS (MD 2.44 mo, 95% CI: 1.45-3.43, P < .001), mortality (RR = 0.27, 95% CI: 0.12-0.61, P = .002), and morbidity (RR = 0.82, 95% CI: 0.46-1.46, P = .514) . GTR was significantly superior to STR in terms of OS (MD 3.77 mo, 95% CI: 2.26-5.29, P < .001), postoperative KPS (MD 4.91, 95% CI: 0.91-8.92, P = .016), and PFS (MD 2.21 mo, 95% CI: 1.13-3.3, P < .001) with no difference in mortality (RR = 0.53, 95% CI: 0.05-5.71, P = .600) or morbidity (RR = 0.52, 95% CI: 0.18-1.49, P = .223).
conclusionsOur findings suggest an upward improvement in survival time, functional recovery, and tumor recurrence rate associated with increasing extents of safe resection. These benefits did not result in higher rates of mortality or morbidity if considered in conjunction with known established safety measures when managing elderly patients harboring HGGs.
Indexed as
AgedAged, 80 and overBiopsyBrain NeoplasmsDisease-Free SurvivalFemaleGliomaHumansKarnofsky Performance StatusMaleMiddle AgedNeurosurgical ProceduresTreatment Outcomeelderlyextent of resectionmalignant gliomameta-analysissystematic review
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