Advantages of Early Surgery for Low-Grade Gliomas

Introduction. Gliomas are the most common malignant tumors of the central nervous system. They are characterised by variability of histological forms, complex localisation, resistance to standard treatment regimens and limited opportunities for complete tumor removal without the risk of neurological complications. Despite the fact that new methods of treatment are being developed, surgery remains the main way to combat the disease. The aim of the article is to study and summarise the results of clinical studies on the efficacy of surgical intervention in low-grade gliomas (LGG). Materials and Methods. Six publications available in the PubMed database (including Medline) were selected for the systematic review. Article selection criteria include the following: study of histologically confirmed gliomas of low malignancy, comparative analysis of the results of early surgical intervention and tactics of careful observation or delayed surgery, availability of data on patient survival for at least two years, study of patients older than 18 years, analysis of both incidental and symptomatic tumors, consideration of the results of partial or complete resection. Results. Studies show that the overall survival rate is higher with early resection than with selected surveillance tactics (14,4 vs 5,8 years). Complete tumor excision reduces the risk of progression and malignisation, with a 5-year survival rate of up to 98 %. Incidental LGGs are more resectable than symptomatic ones. Deferring surgery increases the risk of neurological deficit and transformation to glioblastoma. Complications are lower with early intervention, and the use of intraoperative techniques increases the radicality of resection. Key prognostic factors are resection volume, growth rate (>2 mm/year worsens prognosis) and histological type (oligodendrogliomas have better outcomes). Discussion and Conclusion. Early surgery for LGG has significant advantages: patient survival is increased and the risk of tumor growth and transformation into a malignant form is reduced. The results of the conducted systematic review have limitations for interpretation due to the presence of methodological discrepancies between the reviewed studies, lack of large clinical trials and insufficient consideration of the molecular features of tumors. The decision on timely surgery should be individual, taking into account the rate of tumor growth, the clinic's capabilities and the patient's wishes. Studies with clear criteria and long-term follow-up are needed for more precise conclusions.