BACKGROUND Meningioma is the commonest primary brain tumour. Despite surgery, meningiomas can recur. Surgery is usually the first line treatment for recurrent meningioma. The aim was to determine the risk factors associated with clinical outcomes (performance status, morbidity, mortality, recurrence) following re-operation for recurrence of intracranial meningioma. MATERIAL AND METHODS Retrospective cohort study (1998–2018). Eligible patients had reoperation for local recurrence of a previously operated meningioma. Collected data included baseline clinical and imaging characteristic. Primary outcome measure was performance status after each reoperation. Secondary outcome measures were medical and surgical morbidity, recurrence-free survival (RFS) and overall survival (OS). RESULTS Fifty-eight patients were eligible (37 female, mean age at 1st re-operation 56.1 years (SD=11.6)). Eleven patients (19.6%) had 2 re-operations and 3 patients (5.4%) had 3 re-operations. Median follow up was 128.5 months (IQR=73–194.5). Median time to 1st recurrence and 1st re-operation were 36.5 (IQR=24.3–81.0) and 43.8 months (IQR=20.3–103.4), respectively. Fifteen patients (26.8%) had worse performance status after 1st reoperation, compared to 5.4% (n=3) after the primary operation. Complication rate was 32.1% (n=18) after the primary operation compared to 48.2% (n=27) after 1st reoperation. At primary operation, there were 29 (51.8%) grade 1, 24 (42.9%) grade 2, and 1 (1.8%) grade 3 tumours. Median RFS after first re-operation was 36.5 months (95% CI 29.3–43.9). Median OS was 312 months (95 % CI 257.8–366.2). Increased number of post-operative complications were a risk factor for worsened performance status following reoperation (OR 2.2 [95% CI 1.1–4.6], P=0.029). CONCLUSION Re-operation is associated with a worse performance status and increased risk of complications. Re-operating meningiomas for radiological recurrence without symptoms increases patient morbidity. Shared-care management decision should be made with patients when considering operating for radiological recurrence only.

中文翻译：

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P14.66 复发性脑膜瘤再次手术——我们在帮助患者吗？

背景脑膜瘤是最常见的原发性脑肿瘤。尽管进行了手术，脑膜瘤仍可能复发。手术通常是复发性脑膜瘤的一线治疗。目的是确定与颅内脑膜瘤复发再手术后临床结果（表现状态、发病率、死亡率、复发）相关的危险因素。材料和方法 回顾性队列研究（1998-2018）。符合条件的患者因先前手术的脑膜瘤局部复发而再次手术。收集的数据包括基线临床和影像学特征。主要结果测量是每次再手术后的表现状态。次要结局指标是内科和手术发病率、无复发生存期（RFS）和总生存期（OS）。结果 58 名患者符合条件（37 名女性，第一次再手术的平均年龄 56.1 岁 (SD=11.6))。11 名患者（19.6%）进行了 2 次再次手术，3 名患者（5.4%）进行了 3 次再次手术。中位随访时间为 128.5 个月（IQR=73-194.5）。第一次复发和第一次再次手术的中位时间分别为 36.5 个月（IQR=24.3-81.0）和 43.8 个月（IQR=20.3-103.4）。15 名患者 (26.8%) 在第一次再手术后表现较差，而初次手术后这一比例为 5.4% (n=3)。初次手术后并发症发生率为 32.1%（n=18），而第一次再手术后并发症发生率为 48.2%（n=27）。在初次手术中，有 29 例 (51.8%) 1 级、24 例 (42.9%) 2 级和 1 例 (1.8%) 3 级肿瘤。首次再次手术后的中位 RFS 为 36.5 个月（95% CI 29.3–43.9）。中位 OS 为 312 个月 (95 % CI 257.8–366.2)。术后并发症数量增加是再次手术后体能状态恶化的危险因素（OR 2.2 [95% CI 1.1-4.6]，P=0.029）。结论 再次手术与较差的体能状态和并发症风险增加相关。没有症状的放射学复发再次手术脑膜瘤会增加患者的发病率。在考虑仅针对放射学复发进行手术时，应与患者一起做出共享护理管理决策。