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The effect of preoperative embolization on surgical outcomes for carotid body tumor resection

OBJECTIVE: Compare the effects of preoperative embolization for carotid body tumor resection on surgical outcomes to carotid body tumor resections without preoperative embolization. METHODS: Single-center retrospective review of all consecutive patients who underwent carotid body tumor resection fro...

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Autores principales: Osofsky, Robin, Clark, Ross, Das Gupta, Jaideep, Boyd, Nathan, Olson, Garth, Chavez, LeAnn, Guliani, Sundeep, Langsfeld, Mark, Marek, John, Rana, Muhammad Ali
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013905/
https://www.ncbi.nlm.nih.gov/pubmed/33854776
http://dx.doi.org/10.1177/20503121211005229
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author Osofsky, Robin
Clark, Ross
Das Gupta, Jaideep
Boyd, Nathan
Olson, Garth
Chavez, LeAnn
Guliani, Sundeep
Langsfeld, Mark
Marek, John
Rana, Muhammad Ali
author_facet Osofsky, Robin
Clark, Ross
Das Gupta, Jaideep
Boyd, Nathan
Olson, Garth
Chavez, LeAnn
Guliani, Sundeep
Langsfeld, Mark
Marek, John
Rana, Muhammad Ali
author_sort Osofsky, Robin
collection PubMed
description OBJECTIVE: Compare the effects of preoperative embolization for carotid body tumor resection on surgical outcomes to carotid body tumor resections without preoperative embolization. METHODS: Single-center retrospective review of all consecutive patients who underwent carotid body tumor resection from 2001 to 2019. Surgical outcomes with emphasis on operative time (estimated blood loss and cranial nerve injury) of patients undergoing carotid body tumor resection following preoperative embolization were compared to those undergoing resection alone using unpaired Student’s t-test and Fisher’s exact test. RESULTS: Forty-six patients (15% male, mean age 50 ± 15 years) underwent resection of 49 carotid body tumors. Patients undergoing preoperative embolization (n = 20 (40%)) had larger mean tumor size (4.0 ± 0.7 vs 3.2 ± 1 cm, p = 0.006), increased Shamblin II/III tumor classification (18 (90%) vs 22 (76%), p < 0.001), operative time (337 ± 195 vs 199 ± 100 min, p = 0.004), and cranial nerve injuries overall (8 (40%) vs 2 (10%), p = 0.01) compared to patients undergoing resection without preoperative embolization (n = 29 (60%)). In subgroup analysis of Shamblin II/III classification tumors (n = 40), preoperative embolization (n = 18) was associated with increased tumor size (4.1 ± 0.6 vs 3.5 ± 0.9 cm, p = 0.01), operative time (351 ± 191 vs 244 ± 105 min, p = 0.02), and cranial nerve injury overall (8 (44%) vs 2 (9%), p = 0.03) compared to resections alone (n = 19). In further subgroup analysis of large (⩾ 3 cm) tumors (n = 37), preoperative embolization (n = 18) was associated with increased operative time (350 ± 191 vs 198 ± 99 min, p = 0.006) and cranial nerve injury overall (8 (44%) vs 2 (11%), p = 0.03) compared to resections alone (n = 19). There were no significant differences in estimated blood loss, transfusion requirement, or hematoma formation between any of the embolization and non-embolization subgroups. CONCLUSION: After controlling for tumor Shamblin classification and size, carotid body tumor resections following preoperative embolization were associated with increased operative time and inferior surgical outcomes compared to those tumors undergoing resection alone. Nonetheless, such results remain susceptible to the confounding effects of individual tumor characteristics often used in the decision to perform preoperative embolization, underscoring the need for prospective studies evaluating the utility of preoperative embolization for carotid body tumors.
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spelling pubmed-80139052021-04-13 The effect of preoperative embolization on surgical outcomes for carotid body tumor resection Osofsky, Robin Clark, Ross Das Gupta, Jaideep Boyd, Nathan Olson, Garth Chavez, LeAnn Guliani, Sundeep Langsfeld, Mark Marek, John Rana, Muhammad Ali SAGE Open Med Original Research Article OBJECTIVE: Compare the effects of preoperative embolization for carotid body tumor resection on surgical outcomes to carotid body tumor resections without preoperative embolization. METHODS: Single-center retrospective review of all consecutive patients who underwent carotid body tumor resection from 2001 to 2019. Surgical outcomes with emphasis on operative time (estimated blood loss and cranial nerve injury) of patients undergoing carotid body tumor resection following preoperative embolization were compared to those undergoing resection alone using unpaired Student’s t-test and Fisher’s exact test. RESULTS: Forty-six patients (15% male, mean age 50 ± 15 years) underwent resection of 49 carotid body tumors. Patients undergoing preoperative embolization (n = 20 (40%)) had larger mean tumor size (4.0 ± 0.7 vs 3.2 ± 1 cm, p = 0.006), increased Shamblin II/III tumor classification (18 (90%) vs 22 (76%), p < 0.001), operative time (337 ± 195 vs 199 ± 100 min, p = 0.004), and cranial nerve injuries overall (8 (40%) vs 2 (10%), p = 0.01) compared to patients undergoing resection without preoperative embolization (n = 29 (60%)). In subgroup analysis of Shamblin II/III classification tumors (n = 40), preoperative embolization (n = 18) was associated with increased tumor size (4.1 ± 0.6 vs 3.5 ± 0.9 cm, p = 0.01), operative time (351 ± 191 vs 244 ± 105 min, p = 0.02), and cranial nerve injury overall (8 (44%) vs 2 (9%), p = 0.03) compared to resections alone (n = 19). In further subgroup analysis of large (⩾ 3 cm) tumors (n = 37), preoperative embolization (n = 18) was associated with increased operative time (350 ± 191 vs 198 ± 99 min, p = 0.006) and cranial nerve injury overall (8 (44%) vs 2 (11%), p = 0.03) compared to resections alone (n = 19). There were no significant differences in estimated blood loss, transfusion requirement, or hematoma formation between any of the embolization and non-embolization subgroups. CONCLUSION: After controlling for tumor Shamblin classification and size, carotid body tumor resections following preoperative embolization were associated with increased operative time and inferior surgical outcomes compared to those tumors undergoing resection alone. Nonetheless, such results remain susceptible to the confounding effects of individual tumor characteristics often used in the decision to perform preoperative embolization, underscoring the need for prospective studies evaluating the utility of preoperative embolization for carotid body tumors. SAGE Publications 2021-03-30 /pmc/articles/PMC8013905/ /pubmed/33854776 http://dx.doi.org/10.1177/20503121211005229 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research Article
Osofsky, Robin
Clark, Ross
Das Gupta, Jaideep
Boyd, Nathan
Olson, Garth
Chavez, LeAnn
Guliani, Sundeep
Langsfeld, Mark
Marek, John
Rana, Muhammad Ali
The effect of preoperative embolization on surgical outcomes for carotid body tumor resection
title The effect of preoperative embolization on surgical outcomes for carotid body tumor resection
title_full The effect of preoperative embolization on surgical outcomes for carotid body tumor resection
title_fullStr The effect of preoperative embolization on surgical outcomes for carotid body tumor resection
title_full_unstemmed The effect of preoperative embolization on surgical outcomes for carotid body tumor resection
title_short The effect of preoperative embolization on surgical outcomes for carotid body tumor resection
title_sort effect of preoperative embolization on surgical outcomes for carotid body tumor resection
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013905/
https://www.ncbi.nlm.nih.gov/pubmed/33854776
http://dx.doi.org/10.1177/20503121211005229
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