Comparison of retrocarotid and caudocranial dissection techniques for the surgical treatment of carotid body tumors

Abstract

Carotid body tumors (CBTs) are rare neoplasms. Complete surgical resection is the curative therapy and is considered the therapeutic gold standard. This study compared the retrocarotid dissection (RCD) technique with the standard caudocranial dissection (SCCD) technique in operative time, blood loss, vascular or nerve injuries, and hospital stay. A retrospective review was conducted of patients with CBTs who underwent surgical treatment with the RCD technique at the National Institute of Medical Sciences and Nutrition "Salvador Zubirán" in Mexico City from July 2007 to January 2013. This cohort was compared with an historical cohort treated with standard SCCD from 1995 to 2007 at the same institution. A total of 68 procedures (41 SCCD, 27 RCD) were performed in 68 patients (91% women) with a mean age of 54 years (standard deviation [SD], 15 years). According to the Shamblin classification, 6 CBTs were type I (9%), 35 were type II (51%), and 27 were type III (40%). Comparative analysis identified mean blood loss of 480 mL (SD, 380 mL) in the RCD group and 690 mL (SD, 680 mL) for the SCCD cohort (P < .31). The mean procedural time was 172 minutes (SD, 60 minutes) for the RCD group and 260 minutes (SD, 100 minutes) for the SCCD group (P < .001). Hospital stay was significantly shorter for the RCD group with an average of 5 days (SD, 2 days) compared with 9 days (SD, 6 days) for the SCCD cohort (P < .0001). Cranial nerve deficit occurred in 17 patients, consisting of six transient nerve palsies in the RCD cohort and 11 in the SCCD group. Postoperative cerebrovascular accidents occurred in three patients in the SCCD cohort, with none observed in the RCD group. This translates into a rate of 22% of postoperative neurologic complications for the RCD cohort and 34% in the SCCD group (P < .08). Significant differences in intraoperative vascular injuries were not observed. The RCD technique is a safe and viable option for the surgical resection of CBTs. In our experience, this approach was associated with a significant decrease in procedural time and hospital stay.