Brain Tumor Res Treat.  2023 Jul;11(3):166-172. 10.14791/btrt.2023.0012.

Supramaximal Resection for Glioblastoma: Redefining the Extent of Resection Criteria and Its Impact on Survival

• Roh TH
• Kim SH

• KMID: 2545112
• DOI: http://doi.org/10.14791/btrt.2023.0012

Abstract

Glioblastomas (GBMs) are the most common and aggressive primary brain tumors, and despite advances in treatment, prognosis remains poor. The extent of resection has been widely recognized as a key factor affecting survival outcomes in GBM patients. The surgical principle of “maximal safe resection” has been widely applied to balance tumor removal and neurological function preservation. Historically, T1-contrast enhanced (T1CE) extent of resection has been the focus of research; however, the “supramaximal resection” concept has emerged, advocating for even greater tumor resection while maintaining neurological function. Recent studies have demonstrated potential survival benefits associated with resection beyond T1CE extent in GBMs. This review explores the developing consensus and newly established criteria for “supramaximal resection” in GBMs, with a focus on T2-extent of resection. Systematic reviews and meta-analyses on supramaximal resection are summarized, and the Response Assessment in Neuro-Oncology (RANO) resect group classification for extent of resection is introduced. The evolving understanding of the role of supramaximal resection in GBMs may lead to improved patient outcomes and more objective criteria for evaluating the extent of tumor resection.

Keyword

Glioblastoma; Treatment outcome; Surgical oncology; Computer-assisted image processing; Neurosurgery

Figure

• 

  Fig. 1 Scheme of supramaximal resection of GBM based on RANO resect group criteria. Maximal CE resection (blue) requires less than 1 cm3 of residual contrast-enhanced lesion. Complete CE resection means the absence of a residual contrast-enhanced lesion. It is a subset of maximal CE resection (Class 2). Supramaximal CE resection (green) requires fulfilling Class 2 criteria plus less than 5 cm3 of noncontrast-enhanced lesion.

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