P1.15-06 Resection of Thoracic Paragangliomas: A Multicenter Experience

Abstract

Paragangliomas are chromaffin cell tumor arising from the sympathetic ganglia. Approximately 2% of paragangliomas occur in the thoracic cavity. Surgical resection is an effective treatment with most cases being curative. Tumor recurrence and long-term prognosis data remain scarce. We described our 14-year experience of complete resections. We analyzed surgical characteristics and outcomes from our multicenter cohort of 17 patients with complete paraganglioma resection. We performed a retrospective review from May 2004 to August 2018 across three institutions. Perioperative data were collected using all available medical records from diagnosis to date. Description of baseline demographics, surgical outcomes, complications and survival rates were included in the analysis. Data are reported as mean ± standard deviation (SD) where applicable. A total of 17 patients underwent resection of thoracic paraganglioma. Baseline demographics, operative characteristics and outcomes are presented in Table 1. Mean age at the time of surgery was 46.8 ± 17.2 with ages ranging from 15 to 76 years. Sixty-five percent of patients were male. Eleven patients (64.7%) had the tumor arising from the left atrium, 3 (17.6%) from the mediastinum, 2 (11.8%) from the aorta, and one (5.9%) from both the left and right atria. Eight (47%) patients underwent cardiac autotransplant technique for a better resection approach. Additionally, 2 patients had a concomitant aortic valve and a pulmonic valve replacement, respectively. Complications included tamponade, right ventricular failure requiring RVAD, left ventricular failure requiring IABP, bi-ventricular failure requiring both RVAD and IABP, junctional bradycardia, tracheostomy, and vocal cord paralysis. Recurrence of the tumor presented in three patients (17.6%). One-year, five-year and ten-year survival was 92.3%, 87.5% and 75%, respectively.Table 1ResultsTotal N=17n (%)Age (Mean, years)*46.8 +/- 17.2Male Gender11 (64.7)Race:Caucasian9 (52.9)African American7 (41.2)Hispanic1 (5.9)Preoperative Chemotherapy1 (5.9)Tumor location:Left atrium11 (64.7)Left and right atrium1 (5.9)Mediastinum3 (17.6)Aorta2 (11.8)Surgical Procedure:Autotransplant8 (47)Valve replacement:- Aortic1 (50)- Pulmonic1 (50)Area of Reconstruction:Left Atrium8 (47)Left and right atrium2 (11.8)Right Ventricle and Pulmonary Artery1 (5.9)Aorta1 (5.9)Left main coronary artery1 (5.9)Postoperative Complications:Tamponade2 (11.8)Right Ventricular Heart Failure (RVAD)1 (5.9)Left Ventricular Heart Failure (IABP)1 (5.9)Bi-ventricular Heart Failure1 (5.9)Junctional Bradycardia1 (5.9)Tracheostomy (ventilator dependence)1 (5.9)Vocal cord paralysis1 (5.9)Postoperative Outcomes:Recurrent tumor3 (17.6)Deceased1 (5.9) Open table in a new tab Thoracic paragangliomas are rare and surgically challenging tumors due to their anatomical proximity with surrounding structures. Complete surgical excision is the elective treatment. Surgical mortality is reasonable for this complex disease and long-term outcomes are favorable in patients with complete resection.