Ferrufino MAL, Tanabe PF, Guzmán BP, Vázquez MJC, Melgarejo OGM, Chávez RRC

Language: Spanish
References: 23
Page: 81-86
PDF size: 153.49 Kb.

ABSTRACT

Objective: To assess the epidemiological data, clinical presentation, diagnostic methods, type of treatment and its relation to in-hospital stay, post-operative morbidity and mortality of patients with tumors of the carotid body.
Setting: Caja Nacional de Salud. Hospital Obrero No. 2. Cochabamba-Bolivia.
Design: Retrospective, observational, descriptive study.
Statistical analysis. Percentages as summary measure for qualitative variables.
Patients and methods: We reviewed the clinical records of 30 patients operated in the Surgery Service of the Hospital Obrero N° 2 de la Caja Nacional de Salud, in Cochabamba-Bolivia, with a diagnosis of carotid body tumor, in the last 20 years. Patients were clinically evaluated with complementary studies such as Echo-Doppler, CAT, angiography. Evolution and follow-up was performed in the out-patient clinic with particular attention to neurological deficits.
Results: We found 30 patients with a diagnosis of carotid body tumor in a review of 82,652 performed surgeries, which represents 3.63 per 100,000 patients. Women predominated in this study with 24 cases and average age for both genders was 56 years. Twenty patients presented with an asymptomatic cervical tumefaction. Among the most used diagnostic methods were Echo-Doppler performed in 20 patients and angiography in 18 patients. All patients were grouped according to Shamblin classification criteria and, according to this, 24 patients were operated by cervical approach and complete extirpation; preoperative embolization was performed in two, and four patients were subjected to surgical resection and carotid bypass with vascular reconstruction as they belonged to Shamblin III classification. No operative mortality was recorded. Two patients were managed exclusively with radiotherapy. Average tumor size was of 3-5 cm. All cases were histologically confirmed and postoperative follow-up was of 1 month to 3 years.
Conclusions: The low incidence of these tumors, their extraordinary slow growth, and their site cause diagnostic difficulties. Their diagnostic and therapeutic relevance lies in an early diagnosis with an adequate preoperative evaluation and timely surgical treatment by surgeons trained in all types of procedures to reach high curative rates and low morbidity and mortality.

REFERENCES

1. Khan Q, Heath D, 3Smith P. Anatomical variations in human carotid bodies. J Clin Pathol 1988; 41: 1196-9.

2. Heath D. The human carotid body in health and disease. J Pathol 1991; 164: 1-8.

3. Mondragón-Sánchez A, Montoya RG, Shuchleib-Chaba S. Tumor de cuerpo carotídeo. Ann Med 2003; 48: 233-6

4. Murat E. Surgical techniques for carotid body tumors. URL:http://www.wjso.com/content/3/1/10/comments#175454. Fecha de última consulta:06.03.2005

5. Muhm M, Polterauer P, Gstottner W, Temmel A, Richling B, Undt G, et al. Diagnostic and therapeutic approaches to carotid body tumors. Review of 24 patients. Arch Surg 1997; 132: 279-84.

6. Kohn JS, Raftery KB, Jewell ER. Familial carotid body tumors: a closer look. J Vasc Surg 1999; 29: 649-53.

7. Pacheco-Ojeda L. Malignant carotid body tumors: report of three cases. Ann Otol Rhinol Laryngol 2001; 110: 36-40.

8. Zidi A, Bouaziz N, Mnif N, Kribi L, Kara M, Salah M, et al. Carotid body tumors: contribution of the various imaging techniques. A report of six cases. J Radiol 2000; 81: 953-7.

9. Wang SJ, Wang MB, Barauskas TM, Calcaterra TC. Surgical management of carotid body tumors. Otolaryngol Head Neck Surg 2000; 123: 202-6.

10. Shamblin WR, ReMine WH, Sheps SG, Harrison EG Jr. Carotid body tumor (chemodectoma). Clinicopathologic analysis of ninety cases. Am J Surg 1971; 122: 732-9.

11. Myers EN, Suen JY. Cancer of the head and neck. 3rd ed. Philadelphia: WB Sanders, 1996.

12. Luna-Ortiz K, Rascón-Ortiz M, Villavicencio-Valencia V, Granados-García M, Herrera-Gómez A. Carotid body tumors: review of a 20-year experience. Oral Oncol 2005; 41: 56-61.

13. Ysa-Figueras AY, Miralles M, Bosch JM, Munné M, Pijuan L, Vidal-Barraquer F. Quemodectoma asociado a paragangliomas del vago: resección mediante subluxación mandibular. Angiología 2002; 54: 38-43.

14. González-Fueyo MJ, Ballesteros-Pomar M, Domínguez-Bahamonde J, Zarco-Castillo J, Fernández-Samos R. Tumores del glomus carotídeo: Estudio de 11 años. Angiología 2006; 58: 91-97.

15. Rush BF Jr, Current Concepts in the treatment of carotid body tumors. Surgery 1962; 52: 679-84.

16. Van Asperen, de Boer FR, Terpstra JL, Vink M. Diagnosis, treatment and operative complications of carotid body tumors. Br J Surgery 1981; 68: 433-8.

17. Rodríguez-Cuevas S, López-Garza J, Labastida-Almendaro S. Carotid body tumors in inhabitants of altitudes higher than 2000 meters above sea level. Head Neck 1998; 20: 374-378.

18. Mall J, Saclarides T, Doolas A, Eibl-Eibesfeld B. First report of hepatic lobectomy for metastatic carotid body tumor. J Cardiovasc Surg (Torino) 2000; 41: 759-61.

19. Leonetti JP, Donzelli JJ, Littooy FN, Farrel BP. Perioperative strategies in the management of carotid body tumors. Otolaryngol Head Neck Surg 1997; 117: 111-5.

20. Granell M, Tommasi M, Ubeda J, Chaves S, Soriano JL, Todoli J, et al. Implicaciones anestesiológicas de la exéresis de paragangliomas carotídeos. A propósito de tres casos clínicos. Rev Esp Anestesiol Reanim 2001; 48: 387-92.

21. Laube HR, Fahrenkamp AG, Böcker W, Scheld HH. Glomus tumors: a diagnostic and surgical challenge? Z Kardiol 1994; 83: 373-80.

22. Mayer R, Fruhwirth J, Beham A, Groell R, Poschauko J, Hackl A. Radiotherapy as adjunct to surgery for malignant carotid body paragangliomas presenting with lymph node metastases. Strahlenther Onkol 2000; 176: 356-60.

23. Hallett JW Jr, Nora JD, Hollier LH, Cherry KJ Jr, Pairolero PC. Trends in neurovascular complications of surgical management for carotid body and cervical paragangliomas: a fifty-year experience with 153 tumors. J Vasc Surg 1988; 7: 284-91.