NESVS6. Multispecialty Surgical Management of Carotid Body Tumors in the Modern Era

Abstract

The objective of this study was to assess the perioperative and long-term outcomes of carotid body tumor (CBT) resection with a multispecialty (head and neck surgery/vascular surgery) approach. Our institutional data registry was queried for Current Procedural Terminology codes (60600, 60605) pertaining to CBT excision. These patient records and operative reports were individually reviewed to determine laterality, preoperative tumor embolization, operative time, estimated blood loss, need for intraoperative transfusion, intraoperative electroencephalography changes, intraoperative division of the external carotid artery, carotid artery repair, resection of the carotid bifurcation, tumor volume, final pathology, cranial nerve injury, stroke, death, and clinical or radiographic evidence of recurrence. From 1996 to 2018, there were 74 CBT resections identified in 68 patients (41 [60%] female; mean age, 50.83 years). Mean tumor volume was 84.93 ± 116.15 cm3 (range, 0.2-568 cm3). Embolization was performed by a neurointerventional specialist in 27 (36%) CBT resections based on size (embolization 134 ± 136 cm3 vs 51 ± 84 cm3; P = .005) and superior extension. This resulted in one asymptomatic vertebral dissection that postponed surgery. Blood loss remained significantly higher in the embolization group (470 ± 542 mL vs 227 ± 204 mL; P = .04); however, no transfusions were required in any patient. Mean operative time was also significantly longer in the embolization group (198.88 ± 56.38 minutes vs 153.53 ± 52.45 minutes; P = .00). Three resections had reversible intraoperative electroencephalography changes, one of which occurred during carotid clamping. These changes resolved with shunting. Eight (11%) external carotid resections and six (8.1%) carotid reconstructions (two primary, two patch, two primary anastomosis) were required. Malignant disease was identified in four (5.4%) tumors, accounting for four of six carotid reconstructions. There were no postoperative cranial nerve injuries, no strokes, no re-explorations, and no deaths. One patient developed transient dysphagia from pharyngeal tumor infiltration. Long-term follow-up (mean, 43 ± 54 months), available in 61 of 68 (89.7%) patients, revealed 3 (4.4%) recurrences. This large, single-institution series demonstrates that a multispecialty team combining two surgical skill sets for the treatment of this rare, challenging condition yields unparalleled low complication rates with short operative times. This approach, including long-term surveillance for recurrent disease, should be considered to optimize outcomes of CBT resection.