Outcomes of Carotid Body Tumor Management with Active Surveillance

Lyle, Daniel A; Lopez, Alexis; Osofsky, Robin; Wiemann, Brianne; Boyd, Nathan; Olson, Garth T.; Rana, Muhammad Ali

doi:10.1177/00034894221105833

Cited by 3 publications

(6 citation statements)

References 31 publications

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“…Overall, 66% of those patients remained stable or decreased in size. 16 On the contrary, in the present study, 77% of the tumors increased at least 1 cm 3 . Likewise, in an updated analysis from 2017 about CBT and vagal tumors surveillance from the Leiden University group, 75% of the CBTs increased in size in a median follow-up of 4.7 years.…”

Section: Discussioncontrasting

confidence: 79%

“…The former group had a lower volume growth than the latter group; however, this was not statistically significant. Similarly, Lyle et al 16 found that CBT in patients older than 50 grew 2.3 mm/year slower, on average than CBTs in patients younger than 50, although without a statistically significant difference. Their cohort included 65 patients with 76 CBTs, with a mean tumor size of 24.5 mm.…”

Section: Discussionmentioning

confidence: 90%

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High Altitude Carotid Body Tumors Growth During active Surveillance

González-Urquijo

Hinojosa-González

Fabiani

et al. 2023

Vasc Endovascular Surg

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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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Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 90%

High Altitude Carotid Body Tumors Growth During active Surveillance

González-Urquijo

Hinojosa-González

Fabiani

et al. 2023

Vasc Endovascular Surg

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“…Although it has been reported that active surveillance is a non-inferior option for CBT management [12,13], many other studies have suggested that surgical resection is the preferred treatment [1,9,14]. When performing surgical treatment for CBT, surgeons must consider vascular reconstruction and monitor for cranial neuropathy as described in this study.…”

Section: Discussionmentioning

confidence: 94%

“…Furthermore, as this is an issue directly related to the quality of life, patients should be informed concerning the potential risks, and a multidisciplinary follow-up approach should be considered. As a supplement to this, Lyle et al conducted a trial of active surveillance in patients who did not have symptoms or did not want to undergo surgery for CBTs, and suggested that active surveillance is a reasonable CBT management [22]. However, the aforementioned study also considered the possibility of metastatic progression, which was observed in only 24% of those who did not undergo surgery through the end of the study period.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and challenges of surgical extirpation for carotid body tumor: A single- center case series

Shin

Yun

Kim

2023

Preprint

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Background:Carotid body tumor (CBT) is a highly vascularized, slow-growing tumor of neurovascular origin with very low incidence. Our study aimed to document the characteristics of CBTs and examine the clinical outcomes of patients’ post-surgical extirpation of CBT. Methods: This is a single-center retrospective review of patients who underwent extirpation of CBTs. We documented information concerning patient demographic characteristics, preoperative clinical features, location and size of the tumor, serum and urine catecholamine and metabolite levels, surgical procedures, and postoperative complications. Results: From September 2020 to February 2023, we examined 21 cases of CBT-removal surgery in 19 patients. The most common clinical symptom was painless swelling of the neck (n=12, 57.1%). Seven cases (33.3%) were discovered incidentally; two cases (9.6%) were discovered during the evaluation of neurologic symptoms. One female patient with bilateral CBTs had breast, bone, and lung metastases. During surgery, external carotid artery resection was performed in two cases; one primary repair of the internal carotid artery (ICA) was performed due to an ICA tear during CBT dissection. Bovine patch angioplasty with shunt insertion in the ICA was performed once. All were classified as Shamblin Ⅲ. One patient underwent incomplete resection because the CBT completely surrounded the ICA. Aspiration and hoarseness occurred most frequently as postoperative complications, followed by ipsilateral lower lip drooping, Horner’s syndrome, and first bite syndrome. Hoarseness persisted permanently in two cases (9.5%). Conclusions: Surgeons must understand the relationship between blood vessels and nerves when treating CBTs. Patients should be informed of possible cranial neuropathy resulting from surgery.

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“…Although active surveillance is reportedly a superior option for CBP management [ 11 , 12 ], complete surgical resection is believed as a primary treatment of choice when it is available [ 1 , 6 , 13 ]. When considering surgical removal of CBP, we worry about two things; intraoperative bleeding and CNP.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and challenges of surgical extirpation for carotid body paraganglioma in South Korea: a single-center retrospective study

Shin,

Yun,

Kim

2024

World J Surg Onc

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Background Carotid body paraganglioma (CBP) is a rare, highly vascularized, and slow-growing neuroendocrine tumor. Surgical resection is the definitive treatment for CBP, however, it remains challenging due to the tumor’s proximity to critical blood vessels and cervical cranial nerves. This study aimed to document the characteristics of CBP and examine the clinical outcomes of patients following surgical extirpation of CBP. Methods This is a single-center retrospective review analyzed patients who underwent CBP extirpation. We examined the patient demographics, preoperative clinical features, tumor characteristics, levels of catecholamines and their metabolites in the serum and urine. Surgeries were performed by one vascular surgeon with follow-ups at 1,3,6 months and yearly thereafter. Logistic regression analysis was conducted to identify risk factors associated with the occurrence of either permanent or temporary cervival cranial nerve palsy (CNP). Results From September 2020 to February 2023, this study examined 21 cases of CBP removal surgeries that were carried out in 19 patients. The mean age of the patients was 38.9 ± 10.9 years and the percentage of males was 57.1% (n = 12). The most common preoperative clinical feature was painless neck mass (n = 12; 57.1%). Complete resection was achieved in 20 cases; excluding one case with pathologically proven sclerosing paraganglioma. Vascular procedures were performed in four cases (ECA resection, n = 2; primary repair of ICA tear without carotid shunting, n = 1; and ICA patch angioplasty with carotid shunting, n = 1). Temporary cranial neurologic complications, specifically aspiration and hoarseness occurred in four (19.0%), and three (14.3%) cases, respectively. Hoarseness associated with permanent CNP persisted for more than 6 months in two cases (9.5%). No recurrence or mortality was observed during the follow-up period. Conclusions Surgical resection is the primay treatment approach for CBP; however, it poses risks of vascular or cervical CNP. The intraoperative estimated blood loss was the only identified risk factor for CNP.

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Outcomes of Carotid Body Tumor Management with Active Surveillance

Cited by 3 publications

References 31 publications

High Altitude Carotid Body Tumors Growth During active Surveillance

High Altitude Carotid Body Tumors Growth During active Surveillance

Clinical outcomes and challenges of surgical extirpation for carotid body tumor: A single- center case series

Clinical outcomes and challenges of surgical extirpation for carotid body paraganglioma in South Korea: a single-center retrospective study

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