Effects of Surgical Ventricular Entry on Gliomas Invading the Thalamus: Clinical Outcomes and Economic Burdens.

Abstract

Surgical resection in gliomas invading the thalamus poses significant challenges due to the deep location and its localization near the ventricle. Ventricular entry (VE) during such operation is somewhat inevitable. However, the impact of VE on clinical outcomes is unclear. Additionally, it is unknown whether VE is associated with increased medical costs. This retrospective study was conducted on patients treated at Beijing Tiantan hospital from January 2013 to December 2021. Variables of interest were surgical VE and subventricular (SVZ) contact. Clinical outcomes of interest included perioperative complications, length of stay (LOS), postoperative hydrocephalus, leptomeningeal dissemination and distant parenchymal recurrence, progression-free survival (PFS) and overall survival (OS), and cost of illness was direct medical costs. Analysis was performed using multivariate logistic, Cox regression, and a multivariate generalized linear model. Of the 100 patients pathologically diagnosed with glioma invading the thalamus, 64 (64.0%) patients underwent VE during resection. Multivariate analysis after adjusting confounders revealed that surgical VE, but not SVZ contact, was independently associated with the development of perioperative complications (odds ratio [OR] 3.52, 95% CI 1.19-10.40; P = 0.023), postoperative hydrocephalus (OR 3.70, 95%CI 1.10-12.45; P = 0.035), longer LOS (β 5.99, Wald X² 9.12; P = 0.003) and increased direct medical costs (β 5349.2, Wald X² 4.56; P = 0.033), but not with the distant parenchymal recurrence, PFS, and OS. Although surgical VE does not impact survival, it may impose undesirable events and higher financial burdens for patients with gliomas invading the thalamus.