Introduction and importance: Carotid body tumors (CBT) are neoplasms that originate from chemoreceptors of the carotid body. They are neuroendocrine tumors that are usually benign but may have malignant potential. Malignancy is diagnosed with evidence of lymph node metastasis, distant metastasis, or disease recurrence. Multiple imaging modalities are used to diagnose CBTs and the treatment of choice is surgical excision. Radiotherapy is used for unresectable tumors. In this case, series we describe two cases of malignant paragangliomas that were diagnosed and operated on at a tertiary hospital in Kuwait, by the vascular team. Malignant CBTs are rare, documentation of the cases encountered and the subsequent management and outcome is important to give us a better understanding of the disease. Case presentation: Case one– A 23-year-old woman presented with a right-sided neck mass. History, physical examination, and appropriate imaging suggested malignant paraganglioma with evidence of lymph node, vertebral, and lung metastases. Surgical excision of the tumor and regional lymph nodes was done. Histopathological assessment of the retrieved specimens confirmed the diagnosis. Case two – A 29-year-old woman presented with a left submandibular swelling. She was appropriately investigated, and the diagnosis of a malignant carotid body tumor was made with evidence of lymph node metastasis. Surgical resection of the tumor with clear margins was done and histopathological analysis of the resected specimen confirmed the diagnosis. Clinical discussion: CBT’s are the most common tumors of the head and neck. Most are nonfunctioning, slow growing, and benign. They typically present in the fifth decade of life but can occur at a younger age in individuals who carry certain genetic mutations. Both cases of malignant CBT’s that we encountered occurred in young women. Furthermore, the 4-year and 7-year history in case number one and two, respectively, supports the fact that CBTs are slow growing tumors. In our case series, the tumors were surgically resected. Both cases were discussed in multidisciplinary meetings and were referred for hereditary testing and radiation oncology for further management. Conclusion: Malignant carotid body tumors are rare. Prompt diagnosis and treatment is important to improve patient outcomes.
Introduction: Single incision extra-corporeal appendectomy (SIEA) has emerged as an alternative to the conventional three port appendectomy (CLA). In this study we aim to demonstrate that single incision extracorporeal appendectomy (SIEA) is noninferior to conventional laparoscopic appendectomy (CLA) and more cost effective. Methods and procedures: The following study is a retrospective case-control study of patients who underwent either SIEA or CLA. Data obtained from both groups was analyzed in terms of demographics, comorbidities, symptoms, laboratory findings, Alvarado score, imaging findings, American society of Anesthesia (ASA) score, operative time, intraoperative findings, case performance by surgeon level, and outcomes as well as cost. Wilcoxon test was used to compare continuous data. Fischer’s exact test compared proportions. Significance was defined as p-value < 0.05. Results A total of 156 patients (27 SIEA vs. 129 CLA) were reviewed. SIEA and CLA were similar in mean age, gender, comorbidities, laboratory investigations, Alvarado score, image positivity, ASA score, and intraoperative findings (p > 0.05 for all). Outcomes were similar between the two groups with regards time to advancement of diet (median time 6 hours vs 6 hours), post-operative complications (wound infection, deep seated infections 3.7% vs 4.7%), and readmission rates (3.7% vs 2.3%) (p > 0.05 for all). Length of stay was slightly shorter in the SIEA than the CLA group, despite approaching statistical significance it was not clinically significant (mean 1.7 days vs 2 days p = 0.05). Operative time in SIEA was shorter than CLA (median time 50 min vs 75 min, (p < 0.001). When considering equipment cost, SIEA had a lower cost compared to CLA (mean cost 236 USD vs 632 USD). Conclusion SIEA is noninferior to CLA in terms of outcomes, however it is associated with at least 63% reduction in cost.
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