Morbidity and Long-Term Patient-Reported Outcomes Following Advanced Carotid Body Tumor Resection.

Humans Carotid Body Tumor / diagnostic imaging Cranial Nerve Injuries / etiology Morbidity Retrospective Studies Treatment Outcome Vascular Surgical Procedures / adverse effects

Journal

Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941

Informations de publication

Date de publication:
May 2023
Historique:
received: 04 07 2022
revised: 05 01 2023
accepted: 12 01 2023
medline: 24 4 2023
pubmed: 4 2 2023
entrez: 3 2 2023
Statut: ppublish

Résumé

The reported risk of a cranial nerve (CN) injury is up to 1 in 4 patients in large registries of carotid body tumor (CBT) resection. Functional outcome for this population is unknown. We evaluated consecutive patients who underwent CBT resection from November 2013 through October 2020. Demographics, intraoperative details, complications, and outcomes were recorded from the medical record. Permanent CN nerve injury was defined as deficits lasting >6 months. Frequency statistics, averages, chi-squared test, and multiple logistic regression were completed for primary end points of complications and disease-free survival. Patient-reported outcomes were gathered via telephone survey of patients conducted in September 2021. Fifty-one patients presented with CBTs and the following Shamblin classes: I (n = 7; 14%), II (n = 36; 69%), and III (n = 9; 17%). Head and neck oncology and vascular surgery jointly did 52% of CBT resections, including 6 of 9 Shamblin III cases. Eight patients (15.3%, all Shamblin II or III) suffered a total of 12 CN injuries - 8 CN XII (5 temporary and 3 permanent), 3 CN X (all permanent), and 1 CN XI (permanent). Seven of the CN injury subgroup had preoperative embolization and 5 were joint oncology/vascular cases. In addition, 4 separate carotid injuries required repair. Notably, all patients had disease-free survival postoperatively at a mean follow-up of 6 months. Patient-reported outcomes obtained in 70.6% of patients 1 year or more from index operation demonstrated that two-thirds of patients live without any permanent functional deficits, and the majority of those with continued deficits rate the symptoms as daily but mild in severity. In a series of complex CBT patients treated with preoperative embolization capabilities and multidisciplinary surgical approach, disease-free survival was achieved in all patients despite a high rate of iatrogenic CN injuries, most commonly CN XII. Patient-reported outcomes survey results indicate that injuries identified on clinical exam underreport patients' true postoperative CN deficits - especially branches of CN X. This data support the practice of aggressive primary resection of CBTs while providing guidance for expected functional outcomes due to CN injury risk.

Sections du résumé

BACKGROUND BACKGROUND
The reported risk of a cranial nerve (CN) injury is up to 1 in 4 patients in large registries of carotid body tumor (CBT) resection. Functional outcome for this population is unknown.
METHODS METHODS
We evaluated consecutive patients who underwent CBT resection from November 2013 through October 2020. Demographics, intraoperative details, complications, and outcomes were recorded from the medical record. Permanent CN nerve injury was defined as deficits lasting >6 months. Frequency statistics, averages, chi-squared test, and multiple logistic regression were completed for primary end points of complications and disease-free survival. Patient-reported outcomes were gathered via telephone survey of patients conducted in September 2021.
RESULTS RESULTS
Fifty-one patients presented with CBTs and the following Shamblin classes: I (n = 7; 14%), II (n = 36; 69%), and III (n = 9; 17%). Head and neck oncology and vascular surgery jointly did 52% of CBT resections, including 6 of 9 Shamblin III cases. Eight patients (15.3%, all Shamblin II or III) suffered a total of 12 CN injuries - 8 CN XII (5 temporary and 3 permanent), 3 CN X (all permanent), and 1 CN XI (permanent). Seven of the CN injury subgroup had preoperative embolization and 5 were joint oncology/vascular cases. In addition, 4 separate carotid injuries required repair. Notably, all patients had disease-free survival postoperatively at a mean follow-up of 6 months. Patient-reported outcomes obtained in 70.6% of patients 1 year or more from index operation demonstrated that two-thirds of patients live without any permanent functional deficits, and the majority of those with continued deficits rate the symptoms as daily but mild in severity.
CONCLUSIONS CONCLUSIONS
In a series of complex CBT patients treated with preoperative embolization capabilities and multidisciplinary surgical approach, disease-free survival was achieved in all patients despite a high rate of iatrogenic CN injuries, most commonly CN XII. Patient-reported outcomes survey results indicate that injuries identified on clinical exam underreport patients' true postoperative CN deficits - especially branches of CN X. This data support the practice of aggressive primary resection of CBTs while providing guidance for expected functional outcomes due to CN injury risk.

Identifiants

DOI: 10.1016/j.avsg.2023.01.016 PMID: 36736720
pubmed: 36736720
pii: S0890-5096(23)00028-6
doi: 10.1016/j.avsg.2023.01.016
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

49-56

Informations de copyright

Copyright © 2023 Elsevier Inc. All rights reserved.

Auteurs

Ryan Gupta (R)

Division of Vascular Surgery and Endovascular Therapy, University of Colorado Anschutz School of Medicine, Aurora, CO. Electronic address: ryangupta13@gmail.com.

Gregory Dyba (G)

University of Colorado Anschutz School of Medicine, Aurora, CO.

Emily A Malgor (EA)

Division of Vascular Surgery and Endovascular Therapy, University of Colorado Anschutz School of Medicine, Aurora, CO.

John Campana (J)

Division of Head and Neck Surgery, University of Colorado Anschutz School of Medicine, Aurora, CO.

Mark Nehler (M)

Division of Vascular Surgery and Endovascular Therapy, University of Colorado Anschutz School of Medicine, Aurora, CO.

Rafael D Malgor (RD)

Division of Vascular Surgery and Endovascular Therapy, University of Colorado Anschutz School of Medicine, Aurora, CO.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Morbidity and Long-Term Patient-Reported...
questionsmedicales.fr › Tumeurs › Tumeurs par type histologique › Tumeurs du tissu nerveux › Tumeurs neuroectodermiques › Tumeurs neuroendocrines › Paragangliome › Paragangliome extrasurrénalien › Tumeur du glomus carotidien › Morbidity and Long-Term Patient-Reported...
questionsmedicales.fr › Plaies et blessures › Traumatismes du système nerveux › Traumatismes cranioencéphaliques › Lésions traumatiques des nerfs crâniens › Morbidity and Long-Term Patient-Reported...
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questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie cardiovasculaire › Procédures de chirurgie vasculaire › Morbidity and Long-Term Patient-Reported...