Metastases are the most common brain tumor type, have poor prognosis, and a rising incidence. Benefit from resection of a single brain metastasis prior to adjuvant therapy has been shown; however, there is no similar data evaluating the benefits of multiple metastases resection. A retrospective review identified patients with multiple metastatic brain tumors who underwent resection of >1 metastasis during the same hospitalization. Age, gender, smoking status, number of tumors resected and not resected, resected location, pathology, volume of tumor burden, percent of tumor resected, adjuvant therapy, Karnofsky scores pre/post resection, complications, length of hospital stay, time to intracranial recurrence, Radiation Therapy Oncology Group recursive partitioning analysis class, and overall survival were recorded. Thirty-seven patients were identified, age 22-74 (mean 56.5) years. There were 14 non-small cell pulmonary, 10 melanoma, 2 renal, and 11 other tumors. Eighty-one masses were resected; 31 patients had 2, 5 had 3, and 1 had 4 lesions resected. 10 had unresected lesions after surgery. Karnofsky scores were ≥70 preoperatively and 10 patients had Karnofsky scores <70 postoperatively. Mean hospital stay was 7.7 (range 1-24) days. Mean and median survival was 9.2 and 7.5 months, respectively. In a multivariate analysis, post-surgery Karnofsky score (p = 0.009), number of tumors resected (p = 0.024), and total tumor volume (p = 0.0005) were significant for survival. Resection of multiple brain metastases can be accomplished with acceptable morbidity, but prospective outcome data are lacking. It will be important to document the benefits of such surgery in future research.
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