Correlation between resumption of employment and overall survival following awake mapping-based surgery for IDH-mutant grade 2 glioma: a consecutive series with 515 patients.

Authors

Hugues Duffau

Published in

Journal of neurosurgery. Pages 1-10. Jul 10, 2026. Epub Jul 10, 2026.

Abstract

Although the life expectancy after surgery for IDH-mutant grade 2 glioma (G2G) is now approximately 20 years, the resumption of postresection employment has received little attention. The aim of this study was to identify factors associated with return to work (RTW) following awake mapping-guided resection and its potential impact on long-term outcomes in a homogeneous cohort of patients with G2G.
Patients with G2G who were employed before surgery and had ≥ 2 years of postoperative follow-up were identified from a prospective database of connectome-based awake surgical cases performed by the author between June 1997 and September 2023. Patients who were able to RTW were compared with those who were unable to resume employment following surgery.
This consecutive series included 515 patients (292 male, mean age 36.8 ± 9.2 years). Clinical presentation included 410 patients (79.6%) with epilepsy and 105 (20.4%) with incidental findings. Preoperatively, the mean Karnofsky Performance Scale (KPS) score was 95.7 ± 5.4 and mean tumor volume was 56.3 ± 45.4 cm3. Four patients (0.8%) experienced persistent postoperative neurological deficit. The mean postoperative KPS score was 94.4 ± 6.2, with persistent intractable epilepsy in 34 patients (6.6%). Moreover, 471 patients were able to RTW (91.5%). The mean extent of resection (EOR) was 91.8% ± 8.6%, with supratotal/total EOR in 164 patients (31.8%), and the mean residual tumor volume was 5.8 ± 8.1 cm3. The tumor type was IDH-mutant astrocytoma in 294 patients (57.1%) and oligodendroglioma in 221 (42.9%). Early adjuvant oncological treatment was administered in 80 patients (15.5%), and 161 patients (31.3%) underwent reoperation. The mean follow-up was 8.3 ± 4.3 years, with an overall survival (OS) rate of 79.5%. RTW was correlated with a higher KPS score before and after surgery (p < 0.0001), lower proportion of intractable seizures preoperatively (p = 0.027) and postoperatively (p = 0.001), smaller tumor volume before (p = 0.002) and after (p = 0.004) surgery, greater EOR (p = 0.0004), and absence of early adjuvant therapy (p = 0.013). Moreover, RTW was associated with a higher rate of reoperation (p = 0.026) and longer OS (p = 0.005).
This is the first ever published consecutive cohort study demonstrating that RTW following awake mapping-guided resection of G2G was significantly correlated to better functional status, greater EOR, higher likelihood of further surgery, and prolonged OS, regardless of tumor location and molecular pattern. These findings support earlier and maximum resection, with the goal of preserving the capacity for employment because a more active lifestyle is associated with prolonged life expectancy.

PMID:
42430801
Bibliographic data and abstract were imported from PubMed on 11 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.