Carotid Body Tumor Resection Has A High Rate Of Postoperative Complication
Anna Ramos, MD1, Giancarlo Speranza, BA, BS2, Katherine M. Reitz, MD, MSc3, Mohammad Eslami, MD, MPH3, Michael J. Singh, MD3, Carl H. Snyderman, MD, MBA4, Eric Hager, MD3.
1Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA, 2Grossman School of Medicine, New York University, New York, NY, USA, 3Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA, USA, 4Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA.
OBJECTIVE: Traditionally, carotid body tumor (CBT) resection has been favored due to the potential for both malignant transformation and development of biochemical activity. CBT resection can be complex due to both carotid artery involvement and the proximity of cranial nerves. We therefore hypothesize that CBTs are infrequently biochemically active and/or malignant, but resection results in a high rate of postoperative complications.
METHODS: We searched Medication Administration Records of a multi-hospital, single healthcare system for radiology reports and/or International Classification of Diseases for CBT from 2000-2020. We reviewed the electronic health record identifying patients with diagnosed CBTs; abstracted baseline, diagnostic, treatment, and follow-up data; and compared those who did and did not undergo resection. Among those undergoing resection, we evaluated patient and CBT features for correlation with postoperative complications.
RESULTS: 111 adults were diagnosed with CBT (mean age, 60 years±19; 34% male; 89% unilateral; median follow-up, 4.4 years [range, 2.1-9.0]) of which 55 patients underwent resections. Those who underwent resections were younger (52±16 vs 68±16 years), males (42% vs 23%), with a lower frequency of prior neck surgery (0% vs 9%); resected tumors were larger (2.4 cm [range, 1.8-3.0] vs 2.0 [range, 1.3-2.6]) and both more frequently symptomatic (60% vs 21%) and assessed for biochemical functionality (51% vs 19%; all P<.05) (Table 1). Surgical techniques varied and included preoperative embolization (15%), intraoperative nerve monitoring (18%), and lymph node dissections (29%) with 20% requiring internal carotid repairs. 91% of tumors were benign, of which 4 were biochemically active. 21 major complications occurred in 19 patients (35%), including temporary hemodynamic dysautonomia (N=4), respiratory failure (N=2), stroke (N=1), Horner’s syndrome (N=2), and cranial nerve injuries (N=11). There were no baseline statistically or clinically significant differences between complication groups; however, those with complications had larger tumor diameters (2.7 cm [range, 2.1-3.4] vs 2.2 [range, 1.5-2.8], P=.04). Three benign, nonfunctional tumors had subsequent local recurrence.
CONCLUSIONS: Over 50% of resected CBTs were benign, asymptomatic, non-functional tumors. Given the high rate of postoperative complication and recurrence despite benign pathology, we conclude further work is required to understand outcomes among CBTs that were observed and not resected.
| Table 1. Preoperative Characteristics | No Resection N=56 | Resection N=55 | P- Value | |||
| Baseline Patient Information | ||||||
| Age at diagnosis, years, mean (SD) | 67.7 (15.7) | 51.6 (16.0) | .001 | |||
| Female, No. (%) | 43 (76.8%) | 32 (58.2%) | .04 | |||
| Medical and surgical history, No. (%) | ||||||
| Pheochromocytoma, No. (%) | 0 | 3 (6.4%) | .55 | |||
| Neck surgery, No. (%) | 5 (8.9%) | 0 | .02 | |||
| Family paraganglioma syndrome history, No. (%) | .81 | |||||
| None | 51 (91.1%) | 48 (87.3%) | ||||
| Familial Paraganglioma Syndrome Unspecified (SDH) | 3 (5.4%) | 3 (5.5%) | ||||
| Familial SDHC | 1 (1.8%) | 1 (1.8%) | ||||
| Familial SDHD | 1 (1.8%) | 3 (5.5%) | ||||
| Presenting CBT Information | ||||||
| Incidental imaging diagnosis, No. (%) | 39 (69.6%) | 22 (40.0%) | .02 | |||
| Associated symptoms, No. (%) | 12 (21.4%) | 33 (60.0%) | .001 | |||
| Functional testing, No. (%) | 10 (19.2%) | 25 (51.0%) | .001 | |||
| Positive functional testing result | 0 | 4 (7.3%) | ||||
| Imaging modality, No. (%) | .94 | |||||
| Ultrasound | 5 (8.9%) | 5 (9.1%) | ||||
| Computed tomography | 30 (53.6%) | 29 (52.7%) | ||||
| Magnetic resonance imaging | 17 (30.4%) | 14 (25.5%) | ||||
| Other | 2 (3.6%) | 1 (1.8%) | ||||
| Evaluating service, No. (%) | .001 | |||||
| Vascular surgery | 11 (19.6%) | 20 (37.0%) | ||||
| Otolaryngology | 25 (44.6%) | 33 (61.1%) | ||||
| Neurologic surgery | 5 (8.9%) | 1 (1.9%) | ||||
| Endocrine surgery | 1 (1.8%) | 0 | ||||
| Other | 14 (25%) | 0 | ||||
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