Background: 

High-grade gliomas impose substantial morbidity and mortality due to rapid cancer progression and recurrence. Factors such as surgery, chemotherapy and radiotherapy remain the cornerstones for treatment of brain cancer and brain cancer research. The role of anesthetics on glioma progression is largely unknown.

Methods: 

This multicenter retrospective cohort study compared patients who underwent high-grade glioma resection with minimal sedation (awake craniotomy) and those who underwent craniotomy with general anesthesia (GA). Various perioperative factors, intraoperative and postoperative complications, and adjuvant treatment regimens were recorded. The primary outcome was progression-free survival (PFS); secondary outcomes were overall survival (OS), postoperative pain score, and length of hospital stay.

Results: 

A total of 891 patients were included; 79% received GA, and 21% underwent awake craniotomy. There was no difference in median PFS between awake craniotomy (0.54, 95% confidence interval [CI]: 0.45-0.65 y) and GA (0.53, 95% CI: 0.48-0.60 y) groups (hazard ratio 1.05; P<0.553). Median OS was significantly longer in the awake craniotomy (1.70, 95% CI: 1.30-2.32 y) compared with that in the GA (1.25, 95% CI: 1.15-1.37 y) group (hazard ratio 0.76; P<0.009) but this effect did not persist after controlling for other variables of interest. Median length of hospital stay was significantly shorter in the awake craniotomy group (2 [range: 0 to 76], interquartile range 3 d vs. 5 [0 to 98], interquartile range 5 for awake craniotomy and GA groups, respectively; P<0.001). Pain scores were comparable between groups.

Conclusions: 

There was no difference in PFS and OS between patients who underwent surgical resection of high-grade glioma with minimal sedation (awake craniotomy) or GA. Further large prospective randomized controlled studies are needed to explore the role of anesthetics on glioma progression and patient survival.

中文翻译：

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脑癌进展：清醒开颅术与全身麻醉在高级别胶质瘤切除术中的回顾性多中心比较

背景： 

由于癌症的快速进展和复发，高级别神经胶质瘤会导致大量的发病率和死亡率。手术、化学疗法和放射疗法等因素仍然是治疗脑癌和脑癌研究的基石。麻醉剂对胶质瘤进展的作用在很大程度上是未知的。

方法： 

这项多中心回顾性队列研究比较了接受低度镇静（清醒开颅）高级别胶质瘤切除术的患者和接受全身麻醉（GA）开颅手术的患者。记录各种围手术期因素、术中及术后并发症及辅助治疗方案。主要结果是无进展生存期（PFS）；次要结局是总生存期（OS）、术后疼痛评分和住院时间。

结果： 

共纳入 891 名患者；79% 接受了 GA，21% 接受了清醒开颅手术。清醒开颅术（0.54，95% CI：0.45-0.65 y）和 GA（0.53，95% CI：0.48-0.60 y）组的中位 PFS 没有差异（风险比 1.05；P <0.553） . 与 GA（1.25, 95% CI: 1.15-1.37 y）组相比，清醒开颅手术组的中位 OS 显着更长（1.70, 95% CI: 1.30-2.32 y）（风险比 0.76; P <0.009），但在控制了其他感兴趣的变量后，这种影响并没有持续存在。清醒开颅组的中位住院时间显着缩短（2 [范围：0 至 76]，四分位间距 3 天 vs. 5 [0 至 98]，清醒开颅组和 GA 组的四分位间距分别为 5；P<0.001)。各组之间的疼痛评分具有可比性。

结论： 

接受最小镇静（清醒开颅术）或 GA 手术切除高级别胶质瘤的患者的 PFS 和 OS 没有差异。需要进一步的大型前瞻性随机对照研究来探索麻醉剂对胶质瘤进展和患者生存的作用。