Distinct features of malignant carotid body tumors and surgical techniques for challengeable lesions: a case series of 11 patients.

Distinct features of malignant carotid body tumors and surgical techniques for challengeable lesions: a case series of 11 patients.:

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Distinct features of malignant carotid body tumors and surgical techniques for challengeable lesions: a case series of 11 patients.

Eur Arch Otorhinolaryngol. 2019 Dec 05;:

Authors: Gu G, Wang Y, Liu B, Chen Y, Shao J, Li F, Wu X, Cui L, Lu X, Liu C, Guan H, Gao Z, Feng G, Zheng Y

Abstract

PURPOSE: Malignant carotid body tumor (CBT) is a rare disorder with poor prognosis. In this article, we presented the clinical features and surgical management of malignant CBTs at our department, aiming to improve the outcome for treating such lesions.

METHODS: A retrospective analysis (2005-2018) of CBT excisions at our institution was performed. About 195 patients with CBTs were identified, among which 11 patients with eleven malignant CBTs were identified and carefully reviewed. Data obtained included demographics, radiological details, intra-operative details, post-operative morbidity, and long-term outcomes.

RESULTS: Compared with benign CBTs, malignant CBTs have more advanced Shamblin classification (p < 0.001) and larger tumor size (4.5 ± 2.1 cm vs. 6.7 ± 2.6 cm, p = 0.003). Among the 11 malignant cases, 9 patients underwent surgical resection and 8 cases (8/9, 89%) underwent internal carotid artery (ICA) reconstruction. Intra-operative findings showed that malignant CBTs revealed more severe arterial and nerve adhesions. With the use of specific techniques including pre-reconstruction technique and carotid shunt, all surgeries were successful and no deaths or major complications including stroke or hemiplegia occurred perioperatively and during the follow-up. During the follow-up period (41.6 ± 44.5 months), two patients developed distant metastasis at 7 and 11 years post-operatively. The 5-year and 10-year distant metastasis-free survival rates were 72.7% and 36.4%, respectively.

CONCLUSIONS: With more advanced Shamblin classification and larger tumor size, malignant CBTs remain challengeable for surgery due to severe intra-operative hemorrhage, need of vascular reconstruction and cervical nerve injury. Specific surgical techniques including pre-reconstruction technique and carotid shunt are safe and effective to improve the outcome.

PMID: 31807890 [PubMed - as supplied by publisher]