1
|
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.
Collapse
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.
| |
Collapse
|
3
|
吕 海, 李 谱, 张 名, 曹 连, 王 振. [A case of cervical lymph node metastasis after carotid body tumor surgery]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:475-476. [PMID: 35822369 PMCID: PMC10128488 DOI: 10.13201/j.issn.2096-7993.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Indexed: 06/15/2023]
Abstract
Malignant carotid body tumor is rare, reported this case who had experienced the totally resection of carotid body tumor 16 years ago and presented with cervical tumor now. The patient was a 68 year old male who presented with a low growing left-sided painless neck mass for half a year. Carotid body tumor resection and left carotid artery artificial vascular reconstruction were performed 16 years ago. Physical examination showed that multiple hard and painless masses can be touched behind the left sternocleidomastoid muscle of the neck. Blood routine and biochemical tests were normal. MRI enhancement of the neck showed multiple circular abnormal signals behind the left sternocleidomastoid muscle, with obvious enhancement. The cervical masses of this case were experienced totally resected again, and the postoperative pathology confirmed that it was carotid body tumor and cervical lymph node metastasis. The clinical diagnosis was malignant carotid body tumor with cervical lymph node metastasis. Postoperative PET-CT examination showed multiple lymphadenopathy and abnormal metabolism in hilar, mediastinum and abdominal aorta. Multiple systemic metastasis of malignant carotid body tumor was considered. It was suggested that preoperative whole-body PET-CT examination can be used to evaluate whether the tumor has systemic metastasis.
Collapse
Affiliation(s)
- 海丽 吕
- 首都医科大学宣武医院耳鼻咽喉头颈外科(北京,100053)Department of Otolaryngology Head and Neck Surgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - 谱 李
- 首都医科大学宣武医院耳鼻咽喉头颈外科(北京,100053)Department of Otolaryngology Head and Neck Surgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - 名霞 张
- 首都医科大学宣武医院耳鼻咽喉头颈外科(北京,100053)Department of Otolaryngology Head and Neck Surgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - 连杰 曹
- 首都医科大学宣武医院耳鼻咽喉头颈外科(北京,100053)Department of Otolaryngology Head and Neck Surgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - 振霖 王
- 首都医科大学宣武医院耳鼻咽喉头颈外科(北京,100053)Department of Otolaryngology Head and Neck Surgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| |
Collapse
|