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Brain tumour surgery: experts call for change to improve survival

New research prompts drive to increase specialist neurosurgery access

Brain tumour patients in the UK are more likely to survive major surgery if their operation is carried out by a neurosurgeon with specialist experience of the disease, researchers have found.

The study, published online last week by the British Journal of Cancer, says death rates within 30 days of surgery to remove a brain tumour are lower for surgeons who focus their efforts on neuro-oncology.

The research is the first to show a correlation in the UK between the number of brain tumour patients a surgeon operates on and better outcomes for patients undergoing a brain tumour resection (removal or partial removal).

All previous analyses have been carried out using data from the United States.

The research team was led by Dr Matt Williams, consultant clinical oncologist at Imperial College Healthcare NHS Trust. The work was based on data and analysis supplied by the National Cancer Registration and Analysis Service (NCRAS), part of Public Health England (PHE).

They found that a doubling of surgeon load, in terms of the number of brain tumour resections performed, was associated with a 20% relative reduction in patient mortality.

Dr Williams will now work alongside The Brain Tumour Charity on measures to increase brain tumour patients’ access to specialist neuro-oncology surgeons.

He said, “Although there will always be patients who need an emergency operation, most patients with a brain tumour should be operated on by a surgeon who specialises in brain tumours.

“This isn’t about reducing the number of neurosurgical units – it’s just about reorganising some of the work within those units, and that is something that should be well within our grasp.

“The Brain Tumour Charity has agreed to support a programme of workshops and events to help bring together hospital staff and make these changes happen more quickly.”

Dr Williams and his team analysed data from 9194 operations, 163 consultant neurosurgeons and 30 centres. They highlight a significant potential difference in 30-day mortality between neurosurgeons who operate rarely on brain tumour patients and those who do so frequently.

They say, “Our final model predicts 50 deaths over three years amongst patients of surgeons who operate less than once per month. If these operations had been performed by a surgeon operating once per week the corresponding predicted number of deaths is 28 – a reduction of 44%, although the overall risk is low.”

The team’s findings were welcomed by Emma Tingley, director of services and influencing at The Brain Tumour Charity. She said, “Evidence from the US has shown previously that outcomes there are better for brain tumour patients whose surgeon specialises in neuro-oncology.

“Dr Williams’ research provides for the first time the UK data we need to argue at the highest level for greater sub-specialisation among neurosurgeons, in order to improve survival rates after brain tumour surgery.

“The workshops we are planning in partnership with Dr Williams aim to bring together those from around the UK who can make it happen.”

Dr Williams said, “We hope that the work we have done reinforces the benefits of individual surgeon specialisation.

“Unlike in the USA, in the UK we have the benefit of centralised services concentrated in regional neurosurgical centres, and our centres are much bigger than most American centres.

“In addition, some centres already ensure that brain tumour operations are carried out only by a small number of specialist surgeons.

“That means patients in the UK benefit in general from access to greater expertise than in other countries but there is more we can do in partnership with organisations like The Brain Tumour Charity to improve things further.”

Guidelines published in 2006 by the National Institute for Health and Care Excellence (NICE) suggest that brain tumour surgery should be performed by a surgeon who spends at least 50% of their time devoted to neurosurgery, but this is not always implemented.