Ερευνητικό υλικό ΕΚΠΑ

New predictors of complications in carotid body tumor resection

Αγγλικά

Objective This study examined the relationship between two new variables, tumor distance to base of skull (DTBOS) and tumor volume, with complications of carotid body tumor (CBT) resection, including bleeding and cranial nerve injury. Methods Patients who underwent CBT resection between 2004 and 2014 were studied using a standardized, multi-institutional database. Demographic, perioperative, and outcomes data were collected. CBT measurements were determined from computed tomography, magnetic resonance imaging, and ultrasound examination. Results There were 356 CBTs resected in 332 patients (mean age, 51 years; 72% female); 32% were classified as Shamblin I, 43% as Shamblin II, and 23% as Shamblin III. The mean DTBOS was 3.3 cm (standard deviation [SD], 2.1; range, 0-10), and the mean tumor volume was 209.7 cm3 (SD, 266.7; range, 1.1-1642.0 cm3). The mean estimated blood loss (EBL) was 257 mL (SD, 426; range, 0-3500 mL). Twenty-four percent of patients had cranial nerve injuries. The most common cranial nerves injured were the hypoglossal (10%), vagus (11%), and superior laryngeal (5%) nerves. Both Shamblin grade and DTBOS were statistically significantly correlated with EBL of surgery and cranial nerve injuries, whereas tumor volume was statistically significantly correlated with EBL. The logistic model for predicting blood loss and cranial nerve injury with all three variables—Shamblin, DTBOS, and volume (R2 = 0.171, 0.221, respectively)—was superior to a model with Shamblin alone (R2 = 0.043, 0.091, respectively). After adjusting for Shamblin grade and volume, every 1-cm decrease in DTBOS was associated with 1.8 times increase in risk of >250 mL of blood loss (95% confidence interval, 1.25-2.55) and 1.5 times increased risk of cranial nerve injury (95% confidence interval, 1.19-1.92). Conclusions This large study of CBTs demonstrates the value of preoperatively determining tumor dimensions and how far the tumor is located from the base of the skull. DTBOS and tumor volume, when used in combination with the Shamblin grade, better predict bleeding and cranial nerve injury risk. Furthermore, surgical resection before expansion toward the base of the skull reduces complications as every 1-cm decrease in the distance to the skull base results in 1.8 times increase in >250 mL of blood loss and 1.5 times increased risk of cranial nerve injury. © 2017

2017

Kim, G.Y.
Lawrence, P.F.
Moridzadeh, R.S.
Zimmerman, K.
Munoz, A.
Luna-Ortiz, K.
Oderich, G.S.
de Francisco, J.
Ospina, J.
Huertas, S.
de Souza, L.R.
Bower, T.C.
Farley, S.
Gelabert, H.A.
Kret, M.R.
Harris, E.J., Jr.
De Caridi, G.
Spinelli, F.
Smeds, M.R.
Liapis, C.D.
Kakisis, J.
Papapetrou, A.P.
Debus, E.S.
Behrendt, C.-A.
Kleinspehn, E.
Horton, J.D.
Mussa, F.F.
Cheng, S.W.K.
Morasch, M.D.
Rasheed, K.
Bennett, M.E.
Bismuth, J.
Lumsden, A.B.
Abularrage, C.J.
Farber, A.

Journal of Vascular Surgery

Mosby Year Book Inc

65

6

1673-1679

adult; bleeding; cancer surgery; carotid body tumor; computer assisted tomography; Conference Paper; confidence interval; cranial nerve injury; demography; female; human; hypoglossal nerve; major clinical study; male; middle aged; nuclear magnetic resonance imaging; prediction; priority journal; statistical model; superior laryngeal nerve; treatment outcome; tumor volume; ultrasound; vagus nerve; adverse effects; aged; anatomic landmark; Brazil; carotid body tumor; clinical trial; Colombia; comparative study; complication; computed tomographic angiography; Cranial Nerve Injuries; diagnostic imaging; echography; Europe; factual database; Hong Kong; magnetic resonance angiography; Mexico; multicenter study; odds ratio; operative blood loss; pathology; retrospective study; risk assessment; risk factor; skull base; United States; vascular surgery; very elderly; young adult, Adult; Aged; Aged, 80 and over; Anatomic Landmarks; Blood Loss, Surgical; Brazil; Carotid Body Tumor; Colombia; Computed Tomography Angiography; Cranial Nerve Injuries; Databases, Factual; Europe; Female; Hong Kong; Humans; Logistic Models; Magnetic Resonance Angiography; Male; Mexico; Middle Aged; Odds Ratio; Retrospective Studies; Risk Assessment; Risk Factors; Skull Base; Treatment Outcome; Tumor Burden; Ultrasonography; United States; Vascular Surgical Procedures; Young Adult

https://doi.org/10.1016/j.jvs.2016.12.124

10.1016/j.jvs.2016.12.124

https://pergamos.lib.uoa.gr/uoa/dl/object/3108626