Variations in Surgical Outcomes of Carotid Body Tumors by Surgical Specialty

Abstract

Objectives/Hypothesis A carotid body tumor (CBT) is a rare type of tumor that is divided among multiple surgical specialties. Individual surgeons may have limited experience in treating these tumors. We aim to compare different surgical specialties within a single healthcare system to detect variations in management and outcome. Study Design Retrospective chart review. Methods A chart review of all patients who underwent surgery for CBT at the University of Pittsburgh Medical Center (UPMC) from 2000 to 2019 was carried out. Univariate and multivariate analysis was used for descriptive statistics, comparison of outcomes, and identification of risk factors. Results Fifty‐eight CBT resection surgeries were performed at UPMC. Patients with advanced tumor were 6.7 (95% confidence interval [CI]: 1.36‐32.7) times more likely to undergo preoperative embolization and 8.53 (95% CI: 2.011‐36.19) times more likely to sustain carotid artery injury. Advanced‐stage tumor resections were associated with greater blood loss (P = .03) and longer hospitalization (P = .02). Collaborative surgeries were associated with higher rates of carotid artery injury (P = .003), residual tumor (P < .001), and longer hospitalization (P = .003), as these combined cases were generally reserved for advanced‐stage tumors (P = .02). There were no differences in outcomes between specialties. Of 22 surgeons, the median number of surgeries per surgeon was one (range = 1–12, 54.5%). Conclusions Surgeons who completed only one surgery for CBT had a greater rate of hospital readmission and greater length of hospital stay. Collaborative surgeries had worse outcomes due to more advanced tumors requiring more complex surgeries. Level of Evidence 4 Laryngoscope, 131:E190–E195, 2021

Long-Term Surgical Outcomes of Carotid Body Tumors With Pathological Fibrosis: A Cohort Study

“…The Shamblin classification is predictive of the risk of CNI ( 27 ). Consistent with previous studies, patients with higher Shamblin grade tumors presented with a higher incidence of CNI in our study ( 5 , 18 – 20 ). Here, the occurrence of CNI was higher in the FCBTs than in the CCBTs, especially in Shamblin II CBTs.…”

“…The Shamblin classification is predictive of the risk of CNI (27). Consistent with previous studies, patients with higher Shamblin grade tumors presented with a higher incidence of CNI in our study (5,(18)(19)(20).…”

“…We observed significantly more blood loss in the FCBT group. Patients with tumors with higher Shamblin classifications have been reported to experience greater blood loss and increased need for vascular sacrifice and reconstruction ( 18 – 20 ). Indeed, we observed increased blood loss and ICA reconstruction for CBTs with higher Shamblin classification, but more importantly, we recorded significantly greater blood loss and ICA reconstruction in the FCBTs than in the CCBTs of Shamblin class II and III.…”

Analgesia nociception index for early detection of vagal stimulation during carotid body tumor resection: A case report

“…Carotid manipulation during parapharyngeal space tumor surgery or interventional treatment causes carotid body stimulation, bradycardia, and subsequent hypotension. Previous reports have described variations in surgical outcomes of treatment in terms of hospital stay, readmission, and long‐term complications with multifactorial causes 4 …”

The Importance of Prostate-Specific Membrane Antigen Expression in Carotid Body Paragangliomas

“…While carotid body paragangliomas (CBPs) are uncommon tumors, they account for the majority of the paragangliomas (PGLs) in the head and neck (60-70%) ( 1 ). Patients with persistent hypoxia and complaints like chronic obstructive pulmonary disease, congenital cyanotic heart disease, and those living in high-altitude areas are at risk (especially women) ( 2 , 3 ). Immunohistochemistry shows that PGLs are positive for neuroendocrine markers such as chromogranin and synaptophysin ( 3 ).…”