Research Article
The Value of a Second Operation in Patients with Glioblastoma Multiforme: is it Medically Justified and Ethically Appropriate?
Javad Hekmatpanah1, David Slotwiner2, Mehrnoush Gorjian3 and Robert Wollman4
1Department of Neurosurgery, University of Chicago, Medicine, USA
2Weill Cornell or Columbia Faculty, New York- Presbyterian Queens, USA
3Department of Neurology, University of New Mexico School of Medicine, USA
4Department of Pathology, University of Chicago, USA
Javad Hekmatpanah M.D., Department of Neurosurgery, University of Chicago, Medicine, USA.
Received Date: November 08, 2021; Published Date: November 30, 2021
Abstract
Objective: Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor, having a high incidence of local recurrence.
The question remains if a second operation offers the patient an enough and meaningful longer survival to be medically justified and ethically
appropriate. In this paper we attempt to come up with a reasonable answer through the results in our patients and in similar ones in the literature
Materials and Methods: The records of 49 patients with gross total resection of GBM were reviewed for two groups, comparing 20 patients
with symptomatic recurrence, with that of 29 patients having a second operation. Effects of age, inter-operative duration, and adjuvant therapies on
survival were studied, using univariate and multivariate analysis. The results were compared with similar studies in the literature.
Results: The results indicate median survival of 34 months (mean 38.9) for one operation, and 27.5 months (mean 49.9) for two operations
(p=0.4). Adjuvant therapy, including radiation and chemotherapy with BCNU and Podophyllotoxins, had no significant survival benefit in either
group. Patients younger than 60 years had significantly longer survival (median 32 months) compared with older patients (median 19 months,
p=0.03). Interoperative interval of more than 2 years had significantly longer survivals. (p=0.02).
Conclusions: This study as with those similar in the literature indicates that patients with histological diagnoses of “glioblastoma” significantly
have varied duration of survival; likely caused by difference in the genetic makeup of the tumors, their location, and comorbidity. That creates
uncertainty in recommending a second operation. Yet, a second operation can extend survival in months for younger patients, especially for those
younger than 40 years. Thus, it should be reasonable both ethically and clinically, if selected based on high ethical standard, patient’s informed
consent, and realistic clinical expectation that the extending survival would somehow improve the patient’s medical condition.
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James Ken Jiang, Cui Wong, Ze Dong Jiang. Neural Conductional Impairment in the Brainstem Auditory Pathway in term Infants with Perinatal Problems. Arch Neurol & Neurosci. 11(5): 2021. ANN.MS.ID.000774.
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