PO50AN AUDIT OF THE USE OF POST-OPERATIVE IMAGING FOLLOWING GLIOMA RESECTION

Abstract

INTRODUCTION: Gliomas are by far the most common type of primary brain tumour in adults. High grade gliomas are often managed surgically, with maximal debulking, followed by concomitant chemo-radiotherapy and adjuvant chemotherapy. There is increasing evidence that maximal surgical debulking confers a survival advantage. After surgical debulking, early post-operative MRI scanning is an accurate means by which to assess the extent of residual tumour and may highlight the need to perform second-look surgery prior to oncology treatment. Local protocol implemented at Salford Royal Foundation Trust proposes that all patients should be scanned within 24 to 72 hours subsequent to intended gross macroscopic removal of glioma. METHOD: We performed a retrospective audit of 100 consecutive patients undergoing glioma debulking surgery in 2012/3. The attempted degree of glioma resection, time interval from surgery to scan, and MRI scan reports were assessed. The number of patients returning to theatre for further debulking surgery following attempted total resection was recorded. RESULTS: 47% of patients had an MRI scan within 72 hours following attempted total resection. Of these, 9% returned to theatre for subsequent debulking prior to chemo-radiotherapy. CONCLUSION: A significant proportion of patients having early post-operative imaging are returning to theatre for second surgeries to complete maximal tumour resection. Reasons for second surgery are discussed. Patients not having early post-operative imaging may be missing an opportunity for maximal surgical debulking prior to oncological treatment. A significant rate of return to theatre for second surgery may indicate the need for an intra-operative MRI scanner.