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. 2025 Jul 30;17(15):2516.
doi: 10.3390/cancers17152516.

Comparative Outcomes of Gross Total Resection vs. Subtotal Resection Plus Radiotherapy for Preventing Craniopharyngioma Recurrence: A Meta-Analysis of the Endoscopic Endonasal Approach

Ernest J Bobeff  1   2 , Bartosz Szmyd  1   3 , Wojciech Młynarski  3 , Emmanuel Jouanneau  4   5 , Caroline Apra  6   7   8 , Ming Shen  9 , Zara M Patel  10 , Dariusz J Jaskólski  1 , Theodore H Schwartz  11
Affiliations

Comparative Outcomes of Gross Total Resection vs. Subtotal Resection Plus Radiotherapy for Preventing Craniopharyngioma Recurrence: A Meta-Analysis of the Endoscopic Endonasal Approach

Ernest J Bobeff et al. Cancers (Basel). .

Abstract

Objective: Craniopharyngioma recurrence risk studies comparing gross total resection (GTR) vs. subtotal resection (STR) with radiotherapy (XRT) provide inconclusive or contradictory results. This may be an effect of the small group sizes and diversity in the approaches used. Currently, the endoscopic endonasal approach (EEA) is preferred in craniopharyngioma management. Here, we aimed to perform a meta-analysis comparing recurrence risk after GTR vs. STR plus XRT in patients treated with the EEA regimen.

Methods: We performed a systematic literature search of original English language papers on craniopharyngioma management published in the PubMed, Web of Science, and Scopus databases up to 18 October 2023. Eleven articles included data on recurrence rate after EEA: GTR vs. STR with XRT. We extracted the year of publication, number of patients, surgical approach, extent of resection, and follow-up duration. We used meta-analysis for the odds ratio (OR) in fixed and random effects models and Egger's and Begg's tests to assess heterogeneity and publication bias. Follow-up duration and time to recurrence were additionally included in Kaplan-Meier curves with log-rank test analysis.

Results: We observed a lower recurrence rate in patients after GTR (10%) as compared to STR with XRT (30%), OR = 0.299, p < 0.001. To increase data reliability, we limited our analysis to studies with at least five patients in each subgroup and also observed lower recurrence in patients after GTR (12%) as compared to STR with XRT (27%), OR = 0.376, p = 0.011. Survival analysis confirmed significant differences in recurrence-free survival percentages between these groups (p = 0.008).

Conclusions: To date, this is the largest meta-analysis evaluating the recurrence risk in patients undergoing EEA for craniopharyngioma resection, comparing outcomes between those treated with GTR and those treated with STR plus XRT. The results suggest that GTR significantly reduces recurrence risk.

Keywords: GTR; STR+XRT; craniopharyngioma; outcome; progression.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The PRISMA flowchart for assessing the link between gross total resection vs. subtotal resection with radiation therapy and the recurrence risk of craniopharyngioma after endoscopic endonasal approach resection.
Figure 2
Figure 2
Forest plots showing the comparison between GTR and STR plus XRT groups in patients after EEA for craniopharyngioma resection: (A) all included studies, OR = 0.299 (95%CI: 0.159–0.563; p < 0.001); (B) studies with at least 5 patients in each subgroup, OR = 0.376 (95%CI: 0.177–0.800; p = 0.011). Abbreviations: CI, confidence interval; EEA, endoscopic endonasal approach; GTR, gross total resection; OR, odds ratio; XRT, radiation therapy; STR, subtotal resection.
Figure 3
Figure 3
Kaplan–Meier curve assessing the recurrence-free survival in patients treated using EEA between GTR and STR plus XRT subgroups (p = 0.008). Abbreviations: EEA, endoscopic endonasal approach; GTR, gross total resection; OR, odds ratio; XRT, radiation therapy; STR, subtotal resection.
See this image and copyright information in PMC

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