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Wang YH, Yang J, Zhong H, Wu JJ, Wu K, Hu A, Wu JY, Zhu JH. Prevalence, characteristics, evaluation, and management of carotid body tumors: Systematic analysis based on available evidence. J Vasc Surg 2024:S0741-5214(24)00930-3. [PMID: 38580159 DOI: 10.1016/j.jvs.2024.03.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE Although carotid body tumors (CBTs) are rare, they attract particular attention because of their propensity for malignant transformation and the high surgical risk. Because data are scarce and as it is difficult to achieve a large sample size, no study has yet comprehensively analyzed the characteristics, management, or operative complications of CBTs. Therefore, we collected and analyzed all currently available information on CBTs and used the pooled data to derive quantitative information on disease characteristics and management. METHODS We systematically searched PubMed, Embase, the Cochrane Library, and the Web of Science up to December 1, 2022, for studies that investigated the characteristics and management of CBTs. The primary objective was to identify the prevalence of the various characteristics and the incidence of complications. The secondary objective was to compare patients who underwent preoperative embolization (PE) and those who did not (non-PE), as well as to compare patients with different Shamblin grades and those with and without succinate dehydrogenase (SDH) mutations in terms of CBT characteristics and complications. Two reviewers selected studies for inclusion and independently extracted data. All statistical analyses were performed using the standard statistical procedures of Review Manager 5.2 and Stata 12.0. RESULTS A total of 155 studies with 9291 patients and 9862 tumors were identified. The pooled results indicated that the median age of patients with CBT was 45.72 years, and 65% were female. The proportion of patients with bilateral lesions was 13%. In addition, 16% of patients had relevant family histories, and the proportion of those with SDH gene mutations was 36%. Sixteen percent of patients experienced multiple paragangliomas, and 12% of CBTs had catecholamine function. The incidence of cranial nerve injury (CNI) was 27%, and 14% of patients suffered from permanent CNI. The incidence rates of operative mortality and stroke were both 1%, and 4% of patients developed transient ischemic attacks. Of all CBTs, 6% were malignant or associated with metastases or recurrences. The most common metastatic locations were the lymph nodes (3%) and bone (3%), followed by the lungs (2%). Compared with non-PE, PE reduced the estimated blood loss (standardized mean difference, -0.95; 95% confidence interval [CI], -1.70 to -0.20) and the operation time (standardized mean difference, -0.56; 95% CI, -1.03 to -0.09), but it increased the incidence of stroke (odds ratio, 2.44; 95% CI, 1.04-5.73). Higher Shamblin grade tumors were associated with more operative complications. Patients who were SDH gene mutation-positive were more likely to have a relevant family history and had more symptoms. CONCLUSIONS CBT was most common in middle-aged females, and early surgical resection was feasible; there was a low incidence of serious operative complications. Routine PE is not recommended because this may increase the incidence of stroke, although PE somewhat reduced the estimated blood loss and operation time. Higher Shamblin grade tumors increased the incidence of operative complications. Patients who were SDH gene mutation-positive had the most relevant family histories and symptoms.
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Affiliation(s)
- Yong-Hong Wang
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Jia Yang
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Hao Zhong
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Jun-Jie Wu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Kai Wu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Anguo Hu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Jian-Ying Wu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Ji-Hai Zhu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China.
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Gonzalez-Urquijo M, Hinojosa-Gonzalez DE, Viteri-Pérez VH, Becerril-Gaitan A, González-González M, Fabiani MA, Soto Vaca Guzmán IW, Valda Ameller GE, García-Pérez JDJ, Vaquero-Puerta C, Jaramillo-Vergara VH, Cisneros-Tinoco MA, Santoscoy-Ibarra JM, Cárdenas Figueroa EG, Borja Rojas VE, Salinas Ramos IV, Gonzalez-Valladares AJ, Katherine Perez AC, Bañuelos-Gutierrez G, Garcia Palafox JI, Gardeazabal-Diaz GF, López Aldayuz CA, Barajas-Colón JÁ. Risk Factors for Stroke After Carotid Paraganglioma Surgery. Ann Vasc Surg 2023; 90:137-143. [PMID: 36435423 DOI: 10.1016/j.avsg.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/26/2022] [Accepted: 10/14/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Carotid Paraganglioma Cooperative International Registry (CAPACITY) is an international registry composed of 1,432 patients with carotid body tumors (CBT) from 11 centers from 4 countries. The aim of this study was to identify risk factors for patients who presented stroke after carotid paraganglioma resection. METHODS Clinical characteristics and demographics of patients who presented transoperatively and postoperatively stroke from the CAPACITY database were retrospectively gathered. Regression analysis was performed using single logistic regression with Omnibus' test for possible factors that might contribute to present stroke. RESULTS Out of 1,432 patients, 8 (0.5%) female patients presented stroke. Median age was 53 years (range: 41-70 years). Six strokes occurred transoperatively, diagnosed clinically in the immediate postoperative period. Of them, none of the patients received any further treatment. Three of them died on postoperative day 2, 3, and 4. Two patients developed stroke during the first 24 postoperative hours, patients showed dysarthria, and aphasia. One of them was reintervened with thrombectomy due to thrombosis of the common carotid artery the other patient was treated conservatively. Median follow-up was 16 months (range: 2-72 months). Single logistic regression analysis revealed a history of diabetes mellitus (odds ratio (OR) 7.62), carotid artery disease (OR 17.51), and vascular lesion (OR 2.37) to have significantly increased odds of stroke during CBT surgery. CONCLUSIONS In the present study history of diabetes mellitus, carotid artery disease, and vascular lesion had increased odds of stroke during CBT surgery. Findings are limited by low event rate and even larger cohorts are needed to fully define preventive preoperative strategies for preventing stroke.
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Affiliation(s)
| | | | | | - Andrea Becerril-Gaitan
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico
| | - Mirna González-González
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico; Tecnologico de Monterrey, The Institute for Obesity Research, Monterrey, Nuevo Leon, Mexico.
| | - Mario Alejandro Fabiani
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico.
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Gonzalez-Urquijo M, Hinojosa-Gonzalez DE, Fabiani MA, González-González M, Cardenas-Figueroa EG, Rosero-Aguirre VA, Viteri-Pérez VH. High Altitude Carotid Body Tumors Growth During active Surveillance. Vasc Endovascular Surg 2023:15385744231154089. [PMID: 36683142 DOI: 10.1177/15385744231154089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The gold standard for patients with carotid body tumors (CBT) is surgical resection; nevertheless, some patients are unfit for surgery or, for other reasons, could not be operated on. Active surveillance has been known to be a reasonable strategy for these cases. This study aimed to evaluate tumor growth in unoperated patients with CBTs. METHODS A retrospective review of all unoperated patients with CBT from a single academic hospital diagnosed between 2014 and 2021 was performed. Results of nonparametric testing were presented using the median and ranges for Mann-Whitney-U or Kruskal-Wallis. Significance was defined as a 2-tailed P < .05. RESULTS The cohort included a total of 31 patients, with a median age of 60 years (range: 37-80 years), of which 27 (87.1%) were females. The patients live at a median altitude of 2800 meters (range: 2756-2980 meters) above sea level. Twenty (64.5%) patients had Shamblin I tumors, eight (25.8%) patients had Shamblin II tumors, and three (9.7%) patients had Shamblin III tumors. Median CBT volume at diagnosis was 14.1 cm3 (range: .9 - 213.3 cm3). Median volume at diagnosis of symptomatic tumors was substantially larger than asymptomatic tumors, 49.2 cm3 vs 7.9 cm3, respectively (P = .03). Median growth of the tumors during a median 15-month follow-up (range: 3-43 months) was 3.3 cm3 (range: 0-199.9 cm3). Overall, 77% (n = 24) of the CBTs grew at least 1 cm3. CONCLUSION Most patients in the present study had tumor growth by at least 1 cm3, with a median tumor growth of 3.3 cm.3 In the present study tumor growth was shown to be greater than other low altitude CBT active surveillance studies; therefore, surgical resection should be recommended in patients with CBT living at high altitudes.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- 27746Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, México
| | - David E Hinojosa-Gonzalez
- 27746Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, México
| | - Mario Alejandro Fabiani
- 27746Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, México
| | - Mirna González-González
- 27746Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, México
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Chen S, Xu J, Gu G, Zhang Y, Zhang J, Zheng Y, Huang Y. Perioperative blood pressure and heart rate alterations after carotid body tumor excision: a retrospective study of 108 cases. BMC Anesthesiol 2022; 22:374. [PMID: 36463127 PMCID: PMC9719143 DOI: 10.1186/s12871-022-01917-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Arising from chemoreceptor cells, carotid body tumors (CBTs) are rare neoplasms associated with hemodynamics. Perioperative changes in blood pressure (BP) and heart rate (HR) are not completely understood. METHODS This retrospective, observational, controlled study included all CBT patients from 2013 to 2018 in Peking Union Medical College Hospital. Perioperative changes in BP/HR within or between unilateral/bilateral/control groups were investigated. Perioperative details across Shamblin types were also assessed. RESULTS This study included 108 patients (116 excised CBTs). The postoperative systolic BP and HR increased in both unilateral (mean difference of systolic BP = 5.9mmHg, 95% CI 3.1 ~ 8.6; mean difference of HR = 3.7 bpm, 95% CI 2.6 ~ 4.9) and bilateral (mean difference of systolic BP = 10.3mmHg, 95% CI 0.6 ~ 19.9; mean difference of HR = 8.4 bpm, 95% CI 0.5 ~ 16.2) CBT patients compared with the preoperative measures. Compared with control group, the postoperative systolic BP increased (difference in the alteration = 6.3mmHg, 95% CI 3.5 ~ 9.0) in unilateral CBT patients; both systolic BP (difference in the alteration = 9.2mmHg, 95% CI 1.1 ~ 17.3) and HR (difference in the alteration = 5.3 bpm, 95% CI 1.0 ~ 9.6) increased in bilateral CBT patients. More CBT patients required extra antihypertensive therapy after surgery than controls (OR = 2.5, 95% CI 1.14 ~ 5.5). Maximum tumor diameter, intraoperative vascular injury, continuous vasoactive agent requirement, total fluid volume, transfusion, estimated blood loss, operation duration, postoperative pathology, overall complications, and intensive care unit/hospital lengths of stay significantly varied among Shamblin types. CONCLUSION CBT excision may be associated with subtle perioperative hemodynamic changes. Perioperative management of CBT patients necessitates careful assessment, full preparation and close postoperative monitoring.
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Affiliation(s)
- Si Chen
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, 100730 Beijing, China ,grid.506261.60000 0001 0706 7839State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730 Beijing, China
| | - Jingjing Xu
- grid.506261.60000 0001 0706 7839Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, 100730 Beijing, China ,grid.12527.330000 0001 0662 3178School of Medicine, Tsinghua University, 100084 Beijing, China
| | - Guangchao Gu
- grid.506261.60000 0001 0706 7839State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730 Beijing, China ,grid.506261.60000 0001 0706 7839Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, 100730 Beijing, China
| | - Yuelun Zhang
- grid.506261.60000 0001 0706 7839Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, 100730 Beijing, China
| | - Jiao Zhang
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, 100730 Beijing, China
| | - Yuehong Zheng
- grid.506261.60000 0001 0706 7839State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730 Beijing, China ,grid.506261.60000 0001 0706 7839Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, 100730 Beijing, China
| | - Yuguang Huang
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, 100730 Beijing, China
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Gonzalez-Urquijo M, Castro-Varela A, Barrios-Ruiz A, Hinojosa-Gonzalez DE, Salas AKG, Morales EA, González-González M, Fabiani MA. Current trends in carotid body tumors: Comprehensive review. Head Neck 2022; 44:2316-2332. [PMID: 35838064 DOI: 10.1002/hed.27147] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Carotid body tumor (CBT) is a rare neoplasm that has been increasingly studied during the last decades; nevertheless, it continues to be a topic of controversy. This review aims to provide an update on the general features of CBT and particularly review different treatment strategies and primary outcomes. METHODS Data for this literature review were identified by PubMed, Scopus, and Medline. 93 articles from the initial search were included, as well as 28 relevant studies utilizing the snowballing method; totaling 121 articles about CBT. RESULTS Main features such as anatomy, embryology, genetics, clinical presentation, and diagnosis of CBT are presented, followed by evidence of different treatment strategies such as radiotherapy, preoperative embolization, vascular resection, and vascular reconstruction. Main complications are also discussed. CONCLUSION This review summarizes the most critical aspects regarding CBT. Future studies should compare different treatments to attain the best surgical results with lower morbidity rates.
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Affiliation(s)
| | - Alejandra Castro-Varela
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Alanna Barrios-Ruiz
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | | | - Ana Karen Garza Salas
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Erick Ambriz Morales
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Mirna González-González
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico.,Tecnologico de Monterrey, The Institute for Obesity Research, Monterrey, Nuevo León, Mexico
| | - Mario Alejandro Fabiani
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
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The value of ultrasound for the preoperative assessment of carotid body tumors. Clin Imaging 2022; 87:38-42. [PMID: 35487160 DOI: 10.1016/j.clinimag.2022.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/07/2022] [Accepted: 04/19/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate the value of ultrasound (US) examination for the preoperative assessment of carotid body tumors (CBTs) and to predict surgical outcomes. METHODS A total of 15 CBT lesions in 15 patients were included in this study. CBT measurements determined using US, and included maximal diameter, volume, tumor distance to base of skull (DTBOS), and carotid wall infiltration. A correlation analysis was conducted to determine the correlation between US measurements and surgical outcomes, including estimated blood loss (EBL), cranial nerve injury, surgical time, and hospital length of stay (HLOS). RESULTS EBL showed a high level of correlation with the maximal dimeter (r = 0.596, p < .05) and the volume of the tumor (r = 0.864, p < .05). Surgical time was positively correlated with tumor volume (r = 0.592, p < .05) and negatively correlated with DTBOS (r = -0.554, p < .05). There was no significant correlation (p > .05) shown between cranial nerve injury and US variables. HLOS showed the high degree of correlation with the maximal dimeter (r = 0.658, p < .05), and was also negatively correlated with DTBOS (r = -0.620, p < .00). CONCLUSIONS US examination allows for the visualization of features of CBTs, which is a useful and safe tool to be used to predict surgical outcomes. Further research is necessary to validate this exploration method for the preoperative assessment of CBTs.
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Gu G, Liu Z, Song X, Zheng Y. Surgical Excision of a Functional Carotid Body Tumor Presenting Intraoperative Hypertensive Crisis: A Case Report and Literature Review. Vasc Endovascular Surg 2021; 55:772-776. [PMID: 33813956 DOI: 10.1177/15385744211005932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Carotid body tumor (CBT) is a rare neoplasm arising from the carotid bifurcation. Functional CBTs are extremely rare and are usually associated with elevated serum catecholamine and catecholamine-induced symptoms such as paroxysmal hypertension, palpitations, dizziness, flushing and tachycardia. We reported a 47-year-old female with a functional CBT that was biochemically silent and had no catecholamine-induced symptoms preoperatively, but experienced hypertensive crisis during surgical excision of the lesion. Postoperative pathology confirmed the diagnosis of CBT, and a functional tumor was considered due to the hypertensive crisis during surgical manipulation of the lesion. Under careful management of intraoperative blood pressure and close monitoring of vital sign along with adequate crystalloid infusion after surgery, the tumor was successfully excised and the patient recovered uneventfully during a follow-up period of 12 months. To the best of our knowledge, this is an unusual report of functional CBT presenting merely hypertensive crisis during surgery, with no elevated serum catecholamine or catecholamine-induced symptoms preoperatively. Clinicians should be aware of such lesions so that appropriate medication and gentle manipulation are given when encountering hypertensive crisis during surgical excision of CBTs, to prevent life-threatening cardiovascular complications. The appropriate management and recognition of functional CBTs were also discussed by means of a review of the literature.
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Affiliation(s)
- Guangchao Gu
- Department of Vascular surgery, Peking Union Medical College Hospital, Beijing, China
| | - Zhili Liu
- Department of Vascular surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xitao Song
- Department of Vascular surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yuehong Zheng
- Department of Vascular surgery, Peking Union Medical College Hospital, Beijing, China
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Lozano FS, Muñoz A, de Las Heras JA, González-Porras JR. Simple and complex carotid paragangliomas. Three decades of experience and literature review. Head Neck 2020; 42:3538-3550. [PMID: 32812684 DOI: 10.1002/hed.26421] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 06/01/2020] [Accepted: 07/28/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Carotid paragangliomas are rare tumors. They are usually unique, non-secreting, resectable, and benign. However, additional rare cases of complex tumors (bilateral, secretory, nonresectable, or malignant) complicate the management and final outcomes. METHODS Records of paragangliomas from our hospital are reviewed. Criteria defining complex paragangliomas have been previously defined. These are compared with those of the simple group. RESULTS Fifty patients, two groups: simple (n = 39) and complex (n = 11). The patients in the complex group were significantly younger (47.7 vs 63.8 years). Postoperative nerve complications (45.4% vs 6.3%) and mortality during follow-up (27.3% vs 0%) were significantly more common in the complex group. Vascular complications (0% vs 3.1%) and early mortality (0%) were similarly in both groups. CONCLUSIONS Patients with complex carotid paragangliomas are heterogeneous. The former are younger, exhibit a high degree of diagnostic and therapeutic complexity, and have poorer morbidity and mortality. Surgical experience and interdisciplinary collaboration are essential.
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Affiliation(s)
- Francisco S Lozano
- Department of Angiology and Vascular Surgery, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Angel Muñoz
- Department of Otorhinolaryngology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - José A de Las Heras
- Department of Radiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - José R González-Porras
- Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
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Hu H, Zhao J, Wu Z, Huang B. Level of plasma catecholamine predicts surgical outcomes of carotid body tumors: Retrospective cohort study. Head Neck 2019; 41:3258-3264. [PMID: 31157939 DOI: 10.1002/hed.25827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/22/2019] [Accepted: 05/22/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUNDS Carotid body tumors (CBTs) are rare neoplasms and some of them produce catecholamine. Although operations for catecholamine-producing CBTs are safe, the relationship between prognosis and endocrine function has not been analyzed before. METHODS Patients diagnosed with CBTs in our department between 2009 and 2018 were analyzed. Plasma catecholamine was examined as a variable of surgical outcomes and prognosis by using statistical methods. RESULTS Patients who suffered CBTs and underwent operations were divided into two groups according to their plasma catecholamine. Patients in the normal group had more or heavier surgical complications, such as neurological complications (P = .008) and blood loss (P = .03), than those in the high group. However, overall survival, local recurrence, and remote metastasis were not varied significantly in both groups. CONCLUSIONS A high level of plasma catecholamine was a predictor for the improved operative outcomes of CBTs. Hence, nonfunctional CBTs had further short-term surgical complications.
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Affiliation(s)
- Huanrui Hu
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.,National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Zhoupeng Wu
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
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Robertson V, Poli F, Hobson B, Saratzis A, Ross Naylor A. A Systematic Review and Meta-Analysis of the Presentation and Surgical Management of Patients With Carotid Body Tumours. Eur J Vasc Endovasc Surg 2019; 57:477-486. [PMID: 30902606 DOI: 10.1016/j.ejvs.2018.10.038] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/31/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim was to determine the mode of presentation and 30 day procedural risks in 4418 patients with 4743 carotid body tumours (CBTs) undergoing surgical excision. METHODS This is a systematic review and meta-analysis of 104 observational studies. RESULTS Overall, 4418 patients with 4743 CBTs were identified. The mean age was 47 years, with the majority being female (65%). The commonest presentation was a neck mass (75%), of which 85% were painless. Dysphagia, cranial nerve injury (CNI), and headache were present in 3%, while virtually no one presented with a transient ischaemic attack (0.26%) or stroke (0.09%). The majority (97%) underwent excision, but only 21% underwent pre-operative embolisation. Overall, 27% were Shamblin I CBTs; 44% were Shamblin II; and 29% were Shamblin III. The mean 30 day mortality was 2.29% (95% CI 1.79-2.93). The mean 30 day stroke rate was 3.53% (95% CI 2.91-4.29), while the mean 30 day CNI rate was 25.4% (95% CI 24.5-31.22). The prevalence of persisting CNI at 30 days was 11.15% (95% CI 8.42-14.64). Twelve series (544 patients) correlated 30 day stroke with Shamblin status. Shamblin I CBTs were associated with a 1.89% stroke rate (95% CI 0.92-3.82), increasing to 2.71% (95% CI 1.43-5.07) for Shamblin II CBTs and 3.99% (95% CI 2.34-6.74) for Shamblin III tumours. Twenty-six series (1075 patients) correlated CNI rates with Shamblin status: 3.76% (95% CI 2.62-5.35) for Shamblin I CBTs, 14.14% (95% CI 11.94-16.68) for Shamblin II, and 17.10% (95% CI 14.82-19.65) for Shamblin III tumours. The prevalence of neck haematoma requiring re-exploration was 5.24% (95% CI 3.45-7.91). The proportion of patients with a neck haematoma requiring re-exploration was not reduced by pre-operative embolisation (5.92%; 95% CI 2.56-13.08) vs. no embolisation (5.82%; 95% CI 2.76-11.88). Pre-operative embolisation did not reduce drainage losses (639 mL vs. 653 mL). CONCLUSIONS This is the largest meta-analysis of outcomes after CBT excision. Procedural risks associated with tumour excision were considerable, especially with Shamblin III tumours where 4% suffered a peri-operative stroke and 17% suffered a CNI.
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Affiliation(s)
- Vaux Robertson
- The Leicester Vascular Institute, Glenfield Hospital, Leicester UK
| | - Federica Poli
- The Leicester Vascular Institute, Glenfield Hospital, Leicester UK
| | - Ben Hobson
- The Leicester Vascular Institute, Glenfield Hospital, Leicester UK
| | | | - A Ross Naylor
- The Leicester Vascular Institute, Glenfield Hospital, Leicester UK.
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Novo Martínez G, del Blanco Alonso I, Santos Alcántara E, Rodríguez López I, Zorita Calvo A. Hipertensión arterial refractaria en paciente joven secundaria a tumor del cuerpo carotídeo bilateral productor de catecolaminas. ANGIOLOGIA 2018. [DOI: 10.1016/j.angio.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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12
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Davila VJ, Chang JM, Stone WM, Fowl RJ, Bower TC, Hinni ML, Money SR. Current surgical management of carotid body tumors. J Vasc Surg 2016; 64:1703-1710. [DOI: 10.1016/j.jvs.2016.05.076] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/13/2016] [Indexed: 10/20/2022]
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13
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Galyfos G, Stamatatos I, Kerasidis S, Stefanidis I, Giannakakis S, Kastrisios G, Geropapas G, Papacharalampous G, Maltezos C. Multidisciplinary Management of Carotid Body Tumors in a Tertiary Urban Institution. Int J Vasc Med 2015; 2015:969372. [PMID: 26783464 PMCID: PMC4689957 DOI: 10.1155/2015/969372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 11/17/2022] Open
Abstract
Objective. Aim of this study is to present the experience of our institution in carotid body tumors (CBTs) treatment. Methods. All cases treated in a Vascular Surgery Department within 2.5 years (03/2013-09/2015) were retrospectively evaluated. Demographics, diagnostic, and treatment strategy were recorded. All patients with known CBT underwent ultrasound and magnetic resonance imaging preoperatively. All cases were classified according to the Shamblin type and evaluated by a radiologist, otolaryngologist, and anesthesiologist before and after surgery. Major outcomes included mortality, stroke, cranial nerve injury, and recurrence. Results. Overall, nine patients (mean age: 59.5 ± 16.3 years) with a total of ten CBTs were treated. There was no gender prevalence and most of the cases (55%) were asymptomatic. There were no functional or familial cases. There was only one bilateral case treated in a staged manner. No preoperative embolization of CBTs was performed. Mortality and stroke rates were null. No severe complication was observed in the early and late setting. No malignancy was recorded. Mean follow-up was 15.6 ± 7.8 months. Conclusions. Multidisciplinary management of patients with CBTs is imperative for optimal results, especially in type III tumors, bilateral or functional cases. After careful treatment planning and intraoperative manipulations, complications could be avoided even without preoperative embolization.
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Affiliation(s)
- George Galyfos
- Department of Vascular Surgery, KAT General Hospital, 14561 Athens, Greece
| | - Ioannis Stamatatos
- Department of Vascular Surgery, KAT General Hospital, 14561 Athens, Greece
| | - Stavros Kerasidis
- Department of Vascular Surgery, KAT General Hospital, 14561 Athens, Greece
| | - Ioannis Stefanidis
- Department of Vascular Surgery, KAT General Hospital, 14561 Athens, Greece
| | | | | | - Georgios Geropapas
- Department of Vascular Surgery, KAT General Hospital, 14561 Athens, Greece
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14
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Jackson RS, Myhill JA, Padhya TA, McCaffrey JC, McCaffrey TV, Mhaskar RS. The Effects of Preoperative Embolization on Carotid Body Paraganglioma Surgery. Otolaryngol Head Neck Surg 2015; 153:943-50. [DOI: 10.1177/0194599815605323] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 08/20/2015] [Indexed: 12/12/2022]
Abstract
Objective There is no definitive consensus on the impact of preoperative embolization on carotid body paraganglioma management. The purpose of this study was to assess the effects of preoperative embolization on carotid body paraganglioma excision. Data Sources A systematic search was conducted without limits, and it included studies published on or before July 2013 from PubMed, CINAHL, Web of Knowledge, and the Cochrane Library. Relevant synonyms for the search terms “paraganglioma,”“carotid body tumor,” and “embolization” were applied. Review Methods Studies evaluating patients undergoing surgical intervention with embolization for carotid body tumors were included. Two reviewers independently assessed the titles and abstracts for inclusion and extracted the data. The guidelines set forth by the Cochrane Collaboration were followed in the process of data extraction. Data were pooled with a fixed effects model, and standardized mean difference (SMD) and 95% confidence intervals (95% CIs) are reported. Results A total of 22 studies (15 nonrandomized studies with a comparator, 7 single-arm studies) were included, enrolling 578 patients with 607 tumors. Patients undergoing preoperative embolization had significantly less estimated blood loss compared with those of surgical excision only (12 studies; 295 tumors; SMD: –0.52; 95% CI: –0.77, –0.28). Patients undergoing preoperative embolization had less operative time compared with that of surgical excision only (6 studies; 174 tumors; SMD: –0.46; 95% CI: –0.77, –0.14). Conclusion Surgical excision with preoperative embolization appears to decrease estimated blood loss and operative time when compared with that without preoperative embolization for carotid body paragangliomas.
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Affiliation(s)
- Ryan S. Jackson
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jeffrey A. Myhill
- Department of Otolaryngology, NEA Baptist Clinic, Jonesboro, Arkansas, USA
| | - Tapan A. Padhya
- Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
- Department of Head and Neck Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Judith C. McCaffrey
- Department of Head and Neck Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Thomas V. McCaffrey
- Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
- Department of Head and Neck Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Rahul S. Mhaskar
- Division of Evidence-Based Medicine, Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
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15
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Perioperative visual loss after excision and autografting of a thermal burn to the back. Burns 2014; 40:e31-4. [DOI: 10.1016/j.burns.2013.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 12/28/2013] [Indexed: 11/20/2022]
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16
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Clinical characteristics and strategy for treatment of functional carotid body tumours. Int J Oral Maxillofac Surg 2013; 42:436-9. [DOI: 10.1016/j.ijom.2012.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 06/19/2012] [Accepted: 09/14/2012] [Indexed: 11/21/2022]
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