The Clinical Efficacy Of Eloquent Glioma Surgery Under Awake:A Meta-analysis

Objective Meta-analysis of the clinical efficacy and cost-utility of eloquent glioma surgical resection under awake anesthesia versus general anesthesia,systematically evaluating the advantages of awake anesthesia technology in eloquent glioma surgery,providing evidence-based clinical decisions.Methods A literature search was performed using the Embase、PubMed and Cochrane Library databases from the library build to December 2019 that compared craniotomy for eloquent gliomas resection under AA and GA.Literatures were screened strictly according to the inclusion and exclusion criteria.The final selected literatures were evaluated for quality.Data were extracted and Statistical analysis was performed using Review Manager 5.3software.The clinical outcomes included GTR,EOR,intraoperative blood Loss,operating time,intraoperative adverse events、neurological outcome、postoperative complications、LOS、inpatient cost、QALY、PFS etc.Results A total of 13 studies with 606 patients(264 utilizing AA and 342 utilizing GA)were included in this review.Meta analysis results: Compared with GA,AA can improve the mean EOR(MD,16%;P= 0.02),but the advantage in GTR rate is not significant(OR,1.8;P= 0.20).The incidence of long-term neurological improvement or no change under AA is higher(OR,2.62;P=0.02)than GA;besides,AA can significantly reduce the risk of long-term neurological deficits(OR,0.37;P=0.003)).AA results in a longer QALY(MD,0.5yrs;P <0.00001)and PFS(MD,0.57 yrs;P=0.02)than GA;The Los of AA was shorter(MD,-1.0 days;P=0.001)and the inpatient cost was less than GA(MD,-10400 $;P=0.0002);there was no significant difference in the incidence of postoperative complications between AA and GA(OR,0.68;P=0.18),but the incidence of postoperative nausea and vomiting under AA(OR,0.15;P=0.0004)was significantly lower than GA.In addition,there were no significant differences between the two groups in terms of intraoperative adverse events,duration of surgery,intraoperative blood loss.Conclusion Compared with eloquent glioma surgery under GA,the operation under AA has advantages in terms of EOR(without GTR)、 long-term neurological protection、QALY、PFS,which can improve the quality of postoperative life significantly.In addition,AA does not increase the risk of introperative adverse events and postoperative complications.On the contrary,it can obviously reduce the incidence of postoperative nausea and vomiting.In addition to the clinical efficacy value,its advantages in cost-utility control are also significant,which can reduce length of hospital stay and inpatient cost,Lightening the financial burden on the patient.