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The Journal of Cardiovascular Surgery 2019 Oct 04

DOI: 10.23736/S0021-9509.19.10496-X


lingua: Inglese

Carotid body tumor contemporary management in a high-volume centre

Daniele MASCIA 1 , Gloria ESPOSITO 1, Angela FERRANTE 2, Alessandro GRANDI 1, Germano MELISSANO 1, Roberto CHIESA 1

1 Vascular Surgery Unit, Scientific Institute San Raffaele Hospital, “Vita-Salute” University School of Medicine, Milan, Italy; 2 Vascular Surgery Unit, “A. Gemelli” University Hospital, Catholic University of Sacred Heart School of Medicine, Rome, Italy


BACKGROUND: The aim of this study is to report our results with carotid body tumour (CBT) surgical management.
METHODS: Between 2010 and 2018, 100 CBTs (mean age: 48.0 years, range 21-80 years old) were treated in our centre. The patients were classified in 3 groups according to the size: group I (< 3cm), group II (3 to 5 cm) and group III (>5 cm).
RESULTS: Surgical resection was performed in 88 patients and conservative treatment in 2 cases. Nine patients were treated for bilateral involvement and one of them was also treated again for a relapse. Postoperatively, cranial nerve injury (CNI) was significantly higher in group II [3 (8.3%) vs 16 (31.4%) vs 2 (15.4%); p = 0.030] with no statistical differences between the CN involved. At univariate analysis for CNI, CBT group (p=0.030), maximum diameter (p=0.046), patients presenting with dysphonia (p=0.035) and dysphagia (p=0.007) and patients suffering from any intraoperative complication (p=0.047) were statistically significant. At multivariate analysis the only significant variable was CBT group II (p=0.016). For blood loss, CBT group III (p<0.001), Shamblin class III (p<0.001), Pulmonary disease (p=0.034) and surgery time (p<0.001) were statistically significant. The follow-up of 79 patients
(87.8%) showed a 100% overall survival at median follow-up of 37.7 months (range 2-84.7 months) with freedom from local recurrence of 97.8% (77/79).
CONCLUSIONS: Surgical resection remains the gold standard to obtain complete recovery, although tumour size is to be considered a risk factor for CNI because large CBTs remain at high risk for CNIs.

KEY WORDS: Carotid body tumor; Paragangliomas; Surgical treatment; Vascular complication; Cranial nerve injury

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