Extent of Resection and Survival Outcomes in Glioblastoma

Maximising the surgical removal of glioblastoma remains a cornerstone of multimodal therapy, directly influencing both progression-free and overall survival. Traditional gross total resection (GTR) targets all contrast-enhancing tumour visible on MRI, yet microscopic infiltrative cells frequently extend into surrounding brain tissue. Supra-total or supramarginal resection seeks to remove both the enhancing core and adjacent non-enhancing but infiltrated regions, balancing oncological benefit against functional risk. Innovations in intraoperative imaging, fluorescence guidance and functional mapping under awake craniotomy have enabled surgeons to pursue more extensive resections while preserving neurological function. The degree of resection now integrates volumetric assessment of residual contrast and non-contrast disease, molecular profiles such as MGMT methylation and IDH status, and evolving safety metrics, underscoring the global shift towards precision neurosurgery with the aim of prolonging survival without compromising quality of life.

Research from Nature Portfolio

A retrospective study has compared supratotal resection guided by 11C-methionine PET with standard gross total resection in newly diagnosed IDH-wildtype glioblastoma, finding that patients undergoing the more extensive PET-defined resection experienced predominantly distant rather than local recurrence patterns and not only extended median overall survival beyond that achieved with contrast-only removal but also preserved neurocognitive function under awake mapping. These findings highlight the promise of combining metabolic imaging and functional monitoring to redefine safe resection boundaries.

Extent of Resection and Survival Outcomes in Glioblastoma publication trend

The graph below shows the total number of articles in extent of resection and survival outcomes in glioblastoma across all publications each year (not limited to Nature Index journals).

Technical terms

Gross total resection (GTR): surgical removal of all contrast-enhancing tumour tissue visible on MRI.

Supramarginal resection: extension of surgery beyond the contrast-enhancing core into surrounding infiltrated tissue.

FLAIR abnormality: hyperintense region on fluid-attenuated inversion recovery MRI indicating oedema or microscopic tumour infiltration.

11C-methionine PET: positron emission tomography using a radiolabelled amino-acid tracer to visualise metabolically active tumour beyond MRI enhancement.

Raman spectroscopy: optical method detecting molecular vibrations to distinguish tumour cells from normal brain at high spatial resolution.

References

1. Precise Identification of Glioblastoma Micro‐Infiltration at Cellular Resolution by Raman Spectroscopy. Advanced Science (2024).
2. Supra-complete surgery via dual intraoperative visualization approach (DiVA) prolongs patient survival in glioblastoma. Oncotarget (2016).
3. The Association Between the Extent of Glioblastoma Resection and Survival in Light of MGMT Promoter Methylation in 326 Patients With Newly Diagnosed IDH-Wildtype Glioblastoma. Frontiers in Oncology (2020).
4. Safety metric profiling in surgery for temporal glioblastoma: lobectomy as a supra-total resection regime preserves perioperative standard quality rates. Journal of Neuro-Oncology (2020).
5. Oncological and functional outcomes of supratotal resection of IDH1 wild-type glioblastoma based on 11C-methionine PET: a retrospective, single-center study. Scientific Reports (2021).
6. Feasibility, Safety and Impact on Overall Survival of Awake Resection for Newly Diagnosed Supratentorial IDH-Wildtype Glioblastomas in Adults. Cancers (2021).
7. A Systematic Review and Meta-Analysis of Supramarginal Resection versus Gross Total Resection in Glioblastoma: Can We Enhance Progression-Free Survival Time and Preserve Postoperative Safety?. Cancers (2023).
8. FLAIRectomy: Resecting beyond the Contrast Margin for Glioblastoma. Brain Sciences (2022).