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Distinct features of malignant carotid body tumors and surgical techniques for challengeable lesions: a case series of 11 patients

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Abstract

Purpose

Malignant carotid body tumor (CBT) is a rare disorder with poor prognosis. In this article, we presented the clinical features and surgical management of malignant CBTs at our department, aiming to improve the outcome for treating such lesions.

Methods

A retrospective analysis (2005–2018) of CBT excisions at our institution was performed. About 195 patients with CBTs were identified, among which 11 patients with eleven malignant CBTs were identified and carefully reviewed. Data obtained included demographics, radiological details, intra-operative details, post-operative morbidity, and long-term outcomes.

Results

Compared with benign CBTs, malignant CBTs have more advanced Shamblin classification (p < 0.001) and larger tumor size (4.5 ± 2.1 cm vs. 6.7 ± 2.6 cm, p = 0.003). Among the 11 malignant cases, 9 patients underwent surgical resection and 8 cases (8/9, 89%) underwent internal carotid artery (ICA) reconstruction. Intra-operative findings showed that malignant CBTs revealed more severe arterial and nerve adhesions. With the use of specific techniques including pre-reconstruction technique and carotid shunt, all surgeries were successful and no deaths or major complications including stroke or hemiplegia occurred perioperatively and during the follow-up. During the follow-up period (41.6 ± 44.5 months), two patients developed distant metastasis at 7 and 11 years post-operatively. The 5-year and 10-year distant metastasis-free survival rates were 72.7% and 36.4%, respectively.

Conclusions

With more advanced Shamblin classification and larger tumor size, malignant CBTs remain challengeable for surgery due to severe intra-operative hemorrhage, need of vascular reconstruction and cervical nerve injury. Specific surgical techniques including pre-reconstruction technique and carotid shunt are safe and effective to improve the outcome.

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Acknowledgements

We thank Dachun Zhao, MD (Department of Pathology, PUMCH, Shuaifuyuan 1, Dongcheng District, Beijing 100730, China) for providing the pathological images of the carotid body tumors and malignant lymph nodes.

Funding

This work was supported by the Natural Science Foundation of China (81470586 and 81770481).

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Authors and Affiliations

  1. Department of Vascular Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China

    Guangchao Gu, Bao Liu, Yu Chen, Jiang Shao, Fangda Li, Xiao Wu, Xinxin Lu, Changwei Liu, Heng Guan & Yuehong Zheng

  2. Medical Record Department, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China

    Yi Wang

  3. Department of Internal Medicine, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China

    Lijia Cui

  4. Department of Otolaryngology, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China

    Zhiqiang Gao & Guodong Feng

Authors
  1. Guangchao Gu
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  2. Yi Wang
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  3. Bao Liu
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  4. Yu Chen
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  10. Changwei Liu
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  14. Yuehong Zheng
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Contributions

GG is responsible for the data acquisition, analysis and manuscript drafting and revising; YW, BL and JS are responsible for data collection and manuscript revising; YC, and CL are responsible for data collection and agreed to be accountable for the work; XL, HG, ZG and GF are responsible for data analyzing and manuscript revising; FL, XW and LC are responsible for manuscript revising; YZ is responsible for study design, manuscript revising and final approval of publish.

Corresponding author

Correspondence to Yuehong Zheng.

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Conflict of interest

The authors declare that there are no competing interests.

Ethical approval

The study was approved by the ethics committee of the peking union medical college hospital (PUMCH), China and informed consent was obtained from all patients for publication in this work.

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Gu, G., Wang, Y., Liu, B. et al. Distinct features of malignant carotid body tumors and surgical techniques for challengeable lesions: a case series of 11 patients. Eur Arch Otorhinolaryngol 277, 853–861 (2020). https://doi.org/10.1007/s00405-019-05740-x

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  • DOI: https://doi.org/10.1007/s00405-019-05740-x

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