颈动脉体瘤诊治的临床分析：附38例报告

目的：总结颈动脉体瘤（CBT）的临床特征与诊治经验。 方法：回顾性分析2008年10月—2019年4月在中南大学湘雅医院血管外科治疗的38例CBT患者资料,其中男14例,女24例;年龄23~76岁;单侧36例,双侧2例;40个瘤体中,Shamblin I型6个、II型12个、III型22个。 结果：所有患者均行颈部CTA或MRA明确诊断。38例患者中,3例单侧患者行保守治疗,其余35例患者共37个瘤体行手术切除治疗,其中1例手术患者术前行DSA检查并行双侧颈外动脉栓塞术。无术中死亡病例,手术平均时间（140±48）min,术中平均出血量（194±148）mL;Shamblin I型病变均行单纯CBT切除,Shamblin II、III型病变行单纯CBT切除或CBT切除+其他手术（颈部动脉离断、重建、结扎）。所有手术患者术后病理检查均证实为颈部良性副神经节瘤。术后发生短暂脑神经损伤8例,永久脑神经损伤2例,死亡1例。单纯CBT切除患者的神经损伤发生率明显低于CBT切除联合其他手术患者（P<0.05）。随访半月至10年,手术患者未出现肿瘤复发及其他并发症。3例保守治疗患者均带瘤生存。 结论：CTA或MRA为诊断CBT的首选方法,手术切除是CBT的首选治疗方法。手术方式的选择还需根据瘤体的大小形态以及分型决定。     

颈动脉体瘤的外科治疗：附24例报告

目的:总结颈动脉体瘤(CBT)的诊治经验及其手术并发症的防治。方法:回顾性分析1999年1月—2012年9月收治的24例颈动脉体瘤患者共30侧资料。其中双侧肿瘤6例,单侧18例。结果:24例均手术治疗,其中Shamblin I型17侧行单纯瘤体剥除;Shamblin II型7侧行瘤体剥除及颈外动脉切除;6侧Shamblin III型侧行瘤体剥离、颈内动脉部分切除伴颈内动脉重建术。24例患者肿瘤均完整切除,无手术死亡病例,术后出现短暂性脑神经损伤5侧(16.7%),永久性脑神经损伤1例(3.33%)。随访1~15年,未出现延迟性并发症及肿瘤复发。结论:手术是CBT的最有效方式,根据肿瘤大小及与动脉关系决定手术方式,预后良好。     

颈动脉体瘤的外科治疗

目的 探讨颈动脉体瘤的诊断与外科治疗.方法 分析山东大学附属省立医院血管外科2003年1月至2010年10月收治16例颈动脉体瘤患者,经数字减影血管造影术检查得以最终确诊.采用Shamblin分型标准分型:Ⅰ型3例,Ⅱ型11例,Ⅲ型2例,本组全部行外科手术治疗.3例ⅠⅠ型患者行单纯摘除术.11例Ⅱ型患者中,3例行单纯摘除术,3例行摘除术并颈外动脉切除,3例行摘除术、颈外动脉切除并颈动脉修补术,2例行摘除术、颈外动脉切除并颈内动脉重建术.2例Ⅲ型患者,1例行摘除术、颈外动脉切除并颈动脉修补术,1例行摘除术、颈外动脉切除并颈内动脉重建术.结果 16例患者病理均证实为颈动脉体瘤.无手术死亡、偏瘫和失明.术后并发症中以颅神经损伤最多见,共有7例(43.75%),经对症治疗,6例有不同程度改善,1例遗留永久性13角歪斜.随访13例(81.25%),随访时间2～76个月,平均(42.0±1.2)个月,未见肿瘤复发和远处转移.结论 数字减影血管造影术在颈动脉体瘤的诊断和治疗中具有重要意义,颈动脉体瘤应首选手术治疗,可根据瘤体与血管的关系选择适当的术式.

Abstract：

Objective To discuss the diagnosis and surgical treatment for carotid body tumors (CBT). Methods Retrospective analysis was made on 16 cases of carotid body tumors hospitalized in Shandong Provincal Hospital from January 2003 to October 2010. All patients were diagnosed by digital subtraction angiography, including 3 case of Shamblin type Ⅰ,11 cases of Shamblin type Ⅱ and 2 cases of Shamblin type Ⅲ. Three cases of type Ⅰ and 3 cases of type Ⅱ underwent carotid body tumor resection. Three cases of type Ⅱ underwent carotid body tumor plus external carotid artery resection, 3 cases underwent carotid body tumor plus external carotid artery resection plus carotid artery repairment, 2 cases did carotid body tumor plus external carotid artery resection plus internal carotid artery reconstruction. One of type Ⅲ underwent carotid body tumor plus external carotid artery resection plus carotid artery repairment, and the other one underwent carotid body tumor plus external carotid artery resection plus internal carotid artery reconstruction. Results Diagnosis of CBT was confirmed by pathology in all cases. There was no postoperative death、hemiplegia and blindness. The cranial nerve injury was caused in 7 cases, accounting for 43. 75%. 13 cases ( 81. 25% ) were followed up for 2 to 76 months ( mean 42 months), no tumor recurrence and metastasis was found. Conclusions Digital subtraction angiography (DSA) is important in the diagnosis and therapy of carotid body tumor. Surgical treatment is the choice of therapy for carotid body tumors.     

Sizeable carotid body tumor excision by ultrasonic surgical aspirator: a new technical approach

Carotid body tumors (CBTs) are rare neoplasms. Excision is the preferred treatment and is associated with low mortality and morbidity, although rates of cranial nerve dysfunction postoperatively and blood loss are still high. We herein present a case of a huge CBT, Shamblin group 3, managed successfully by the use of the Cavitral Ultrasonic Surgical Aspirator after preoperative superselective embolization. Our goal was to minimize the possibility of cranial nerve injury, blood loss, and vascular reconstruction. Careful preoperative evaluation, management, and intraoperative precision are essential for successful outcomes. Ultrasonic dissection of a CBT allows a precise and energy-controlled approach, minimizing intraoperative complications in such a demanding and delicate operation.     

Late outcome after surgical management of carotid body tumors from a 20-year single-center experience

Background and aims  Surgical resection is the treatment of choice for carotid body tumors. The aim of this study was to assess not only the perioperative, but also the long-term outcome after surgical treatment. Patients/methods  All patients that were operated on a carotid body tumor at our institution between 1986 and 2006 were reviewed. Data collection included patient profile, intraoperative findings and postoperative outcome. Results  Seventeen patients (11 female, six male) with 17 carotid body tumors (12 right, five left sided) were identified. Mean patient age at treatment was 49 years (range 19 to 76 years). Eight patients (47.1%) had large Shamblin type III tumors. Complete tumor resection was achieved in 16 of 17 cases (94.1%). Malignacy could not be proven in any patient. The 30-day mortality and stroke rates were 0. The incidence of temporary and permanent cranial nerve deficit was 41.2% and 11.8%, respectively. Patients with type III tumors had significantly higher risk of neurologic complications than patients with smaller tumors (p = 0.0152). The median postoperative follow-up was 6.4 years (range 1.5 to 20 years). The overall survival rate was 82.4%; the disease-specific survival rate was 94.1% (16 of 17 patients). One patient (5.6%) died of local tumor recurrence 3 years after a R1 resection. All the other patients showed no signs of local recurrence or metastases. Conclusions  The surgical therapy of carotid body tumors shows low long-term morbidity, mortality, and recurrence rates. Cranial nerve injury is mostly temporary but a relevant procedure-related complication. Surgical resection is indicated also for small, asympomatic tumors, because of the uncomplicated resectability of these tumors. Presented at the Annual Scientific Congress of the German, Swiss and Austrian Societies for Vascular Surgery, Basel Switzerland, September 2007.     

Contemporary management of carotid body tumors in a Midwestern academic center

BackgroundCarotid body tumors are rare, neurogenic tumors arising from the periadventitial chemoreceptive tissue of the carotid body. The purpose of this study is to ascertain the presentation and preoperative risk factors associated with surgical resection.MethodsA single-center retrospective review of 25 carotid body tumor resections from 2002 to 2019. Demographics, periprocedural details, and postoperative outcomes were analyzed using Stata (Stata Corporation, College Station, TX).ResultsAmong 25 patients, 64% were women, 84% were asymptomatic, and the mean age was 49 years (range 21–79). Forty-four percent of tumors were Shamblin III. Nine patients underwent preoperative embolization but did not correlate with decreased blood loss (299 cm³ vs 205 cm³, P = .35). The 30-day death, stroke, and cranial nerve injury rates were 0%, 8%, and 32%, respectively. Cranial nerve injuries included 20% vagus, 4% hypoglossal, 4% facial, and 4% glossopharyngeal, with permanent deficits in 4% (n = 1). Mean length of stay was 3.0 days (range 1–9 days). At a mean follow-up of 12 months (range 1–63 months), there has been no recurrence.ConclusionAlthough carotid body tumors are uncommon in the Midwest, complete surgical resection is curative of these typically hormonally inactive tumors. Preoperative embolization did not affect blood loss, and the incidence of death, stroke, and permanent cranial nerve injury rates remained very low.     

A multidisciplinary approach to carotid paragangliomas

The surgical management of carotid paragangliomas can be problematic. A multidisciplinary approach was used to include vascular surgery, otolaryngology, and neuroradiology to treat these patients over 9 years. From January 1992 to July 2001, a multidisciplinary team evaluated patients with carotid paragangliomas. Analyzed patient data included age, gender, diagnostic evaluation, tumor size, preoperative tumor embolization, operative exposure, need for extracranial arterial sacrifice/reconstruction, postoperative morbidity including cranial nerve dysfunction, and long-term follow-up. Twenty-five carotid paragangliomas in 20 patients underwent multidisciplinary evaluation and management. Average age was 51 years (range, 28-83 years), and 52% were male. Diagnostic evaluation included computed tomography in 76%, magnetic resonance imaging/magnetic resonance angiography in 52%, catheter angiography in 60%, and duplex ultrasonography in 16%. An extended neck exposure was required in 11 cases (44%), mandibulotomy was used once (4%), and mandibular subluxation was never required. The external carotid artery (ECA) was sacrificed in 8 cases (32%). The carotid bifurcation was resected in 1 patient (4%) requiring interposition reconstruction of the internal carotid artery. Preoperative tumor embolization was performed for 13 tumors (52%). Operative blood loss for patients undergoing preoperative embolization (Group I) was comparable to the nonembolized group (group II): group I lost 365 +/-180 mL versus 360 +/- 101 mL for group II (P = .48). This occurred despite larger tumors (group I - 4.2 cm versus group II - 2.1 cm, P = .03) and a higher mean Shamblin class (group I - 2.5 versus group II - 1.45, P = .001) for group I. There were no perioperative mortalities. Transient cranial nerve dysfunction occurred in 13 CBTs (52%), 2 (8%) of which remained present after 4 months. Patients with carotid paragangliomas benefit from a multidisciplinary team approach. Neuroradiology has been used for selective preoperative embolization, which has decreased estimated blood loss during excision of larger complex tumors. A combined surgical team of otolaryngology and vascular surgery provides for exposure of the distal internal carotid artery as high as the skull base, limited permanent cranial nerve dysfunction, and selective early division and excision of the external carotid artery for complete tumor resection.     

Role of Malignancy and Preoperative Embolization in the Management of Carotid Body Tumors

The purpose of this retrospective study is to present our approach to the management of patients with carotid body tumors (CBTs), emphasizing the role of malignancy and preoperative embolization. Between 1975 and 1998 a series of 18 patients with CBTs were treated, and 16 of them underwent successful excision of the tumor. According to the Shamblin classification, six of the tumors were type I, six type II, and six type III. In three of these patients (two with type II tumors and one with type III) in whom preoperative embolization had been performed, mean intraoperative blood loss was 400 ml, whereas in the remaining 13 cases this loss was 700 ml. Two patients with intracranial tumor spread underwent only radiotherapy. Neither postoperative deaths nor strokes occurred. Temporary cranial nerve injury occurred in four cases (25%). Local lymph node invasion was found in two patients, establishing the diagnosis of malignancy. One of these patients developed distal metastases 3 years after the operation and was treated with radiotherapy and octreotide. Follow-up ranging from 30 months to 23 years (mean 5 years) revealed no local recurrence except for the two patients who were treated with radiotherapy only. In conclusion, surgical excision remains the treatment of choice for CBTs and can be performed without major risks and with low morbidity and mortality. Preoperative embolization is helpful by diminishing intraoperative bleeding, and malignancy, though rare justifies early management.     

介入联合颈内动脉转流在Ⅲ型颈动脉体瘤切除术中的应用

目的探讨介入联合颈内动脉转流在Ⅲ型颈动脉体瘤切除术中的应用及效果。方法回顾性分析笔者所在医院自2002年1月至2012年7月期间收治的2l例（22侧）Ⅲ型颈动脉体瘤患者的临床资料。21例患者术前经充分评估后,于术前2～3d均用微导管对供瘤血管行超选择栓塞治疗,然后在颈内动脉转流下行颈动脉体瘤切除术。结果21例（22侧）手术均顺利完成,术后经病理学检查证实均为颈动脉体瘤。其中行颈动脉瘤切除术16例（17侧）,瘤体切除＋颈内动脉重建5例（其中自体大隐静脉3例,人工血管2例）。术后当天则出现神经并发症5例（舌歪3例,面部麻木2例）,术后3个月内均恢复正常;无脑梗塞、偏瘫和死亡病例。21例均获随访,随访时间2个月～9年,平均57个月,无复发病例。结论颈动脉体瘤首选的治疗方式是外科切除,介入联合颈内动脉转流下切除Ⅲ型颈动脉体瘤瘤体是安全有效的。     

颈动脉体瘤的外科治疗

目的 总结颈动脉体瘤的外科治疗经验.方法 从1994年起共手术治疗颈动脉体瘤54例,其中男39例,女15例,男女比例为2.6:1.发病年龄22～53岁,平均年龄31岁.所有瘤体均为良性和单侧发病.手术方法包括:单纯颈动脉体瘤瘤体切除12例;瘤体加颈外动脉切除5例;颈动脉体瘤切除加颈内动脉血管重建6例(其中4例应用大隐静脉,2例应用直径6 mm的PTFE人工血管);借助颈动脉内转流切除瘤体32例(包括3例颈内动脉重建者);因瘤体位置太高需打断下颌骨切除瘤体者2例.结果 54例瘤体均完全切除,无复发,无转移病例.无1例发生脑缺血并发症.颈部神经损伤7例,其中交感神经和喉上神经损伤各2例,喉返神经损伤3例.结论 颈动脉转流管有助于颈动脉体瘤切除,需切除颈内动脉者应予以重建,瘤体位置过高者打断下颌骨可增加显露.     

Management of cervical paragangliomas: review of a 15-year experience

Background and aims Cervical paragangliomas are highly vascular neoplasms and should be considered in the evaluation of all lateral neck masses. The aim of this study is to review an institutional experience in the management of these tumors.Materials and methods Thirteen patients with 14 paragangliomas were treated in our institution during a period of 15 years. There were eight women (61.5%) and five men (38.5%) with a mean age of 41.3±15 years. A painless lateral neck mass was the main finding in 69.2% of patients. There was no evidence of a functional tumor. Carotid angiography was performed in all patients to define the vascular anatomy of the lesion. The 78.6% of paragangliomas underwent selective embolization of the major feeding arteries. Surgical resection followed within the next 48 h.Results The majority of the lesions were paragangliomas of the carotid bifurcation (85.7%), while one patient was diagnosed with a jugular and one with a vagal paraganglioma. In one patient, bilateral paragangliomas in the carotid bifurcation were detected. There was no evidence of malignancy in any case. Preoperative embolization has proven successful in reducing tumor vascularity. Vascular reconstruction was necessary in one patient. The main postoperative complication was transient cranial nerve deficit in seven (53.8%) patients, and a permanent Horner’s syndrome was documented in one patient. No stroke occurred. The jugular paraganglioma was treated with irradiation due to skull base extension with significant symptomatic relief.Conclusion Combined therapeutic approach with preoperative selective embolization followed by surgical resection by an experienced team offers a safe and effective method for complete excision of the tumors with a reduced morbidity rate.     

Complications of surgery for giant cell tumor of bone in the extremities: Incidence,risk factors,management modality,and impact on functional and oncological outcomes

BackgroundDue to the wide variations in location, size, local invasiveness, and treatment options, the complications associated with surgery for giant cell tumor of bone have been sporadically reported. For quality assessment, fundamental data based on large-scale surveys of complications under a universal evaluation system is needed. The Dindo-Clavien classification is an evaluation system for complications based on severity and required intervention type and is suitable for the evaluation of surgery in a heterogeneous cohort.MethodsA multi-institutional retrospective survey of 141 patients who underwent surgery for giant cell tumor of bone in the extremity was performed. The incidence and risk factors of complications, type of intervention for complication control, and impact of complications on functional and oncological outcomes were analyzed using the Dindo-Clavien classification.ResultsForty-six cases (32.6%) had one or more complications. Of them, 18 (12.8%), 11 (7.8%), and 17 (12.1%) cases were classified as Dindo-Clavien classification grade I, II, and III complications, respectively. There were no cases with grade IV or V complications. Progression in Campanacci grading (p = 0.04), resection (over curettage, p < 0.0001), reconstruction with prosthesis (p = 0.0007), and prolonged operative duration (p = 0.0002) were significant risk factors for complications. Complications had a significant impact on function (p < 0.0001). Differences in the impact of complication types and tumor location on function were confirmed. Complications had no impact on local recurrence and metastasis development.ConclusionThe Dindo-Clavien classification could provide fundamental information, under a uniform definition and classification system, on postoperative complications in patients with giant cell tumor of bone in terms of incidence, type of intervention for complication control, risk factors, and impact on functional outcome. The data are useful not only for preoperative evaluation for the risk of complications under specific conditions but also for quality assessment of surgery for giant cell tumor of bone.     

颈动脉体瘤的外科治疗

目的 总结颈动脉体瘤外科治疗经验。方法 回顾性分析中山大学附属第一医院血管外科1980年1月至2006年12月的59例62侧颈动脉体瘤手术,按照是否行术前供瘤血管栓塞分为两组,比较其手术方式、手术效果以及并发症发生情况;探讨转流管在颈内动脉重建中的意义;通过随访结果探讨病理学诊断意义。结果 栓塞组和未栓塞组的出血量、颅神经损伤发生率的差异均有统计学意义;11例手术病人进行颈内动脉重建,其中6例使用内转流;术后脑梗塞2例,均为使用内转流病人,其中1例死亡;21例病人术后发生27例次的颅神经损伤,占33.87%,绝大多数为暂时性损伤,仅有1例为永久性损伤。术后病理证实62侧颈动脉体瘤中59侧良性,3侧恶性,随访均未见复发和转移。结论 术前供瘤血管的超选择性栓塞可以明显的减少手术出血量,减少颅神经的损伤发生率,降低手术风险,栓塞后24～48h为手术的最佳时机;颈内动脉重建时不建议常规使用内转流。组织形态学表现不足以判定其良恶性,而应根据其生物学行为,因此对颈动脉体瘤病人必须做好随访。     

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??Surgical therapy of carotid body tumor LV Wei-ming*,LIU Rui-lei,Li Jie,et al. *Department of Vascular Surgery , the First Affiliated Hospital , Sun Yat-sen University, Guangzhou 510080 , China Corresponding author:WANG Shen-ming, E-mail:lijie3218@sina.com Abstract Objective To summarize our treatment experience of carotid body tumor. Methods Retrospectively analyze the clinical data of 59 cases(62 sides) of carotid body tumor from Jan 1980 to Dec 2006,including their preoperative preparations,operative procedures,and complications. Evaluate the value of preoperative superselective arteriography plus emboliazation before surgery. Results The intraoperative blood loss and cranial nerve injury significantly decreased in the embolism group( P < 0.01; P < 0.05).11 interal carotid artety reconstructions were carried out, internal shunts were used in 6 cases and 2 cases of them suffered cerbral infarctions(33.3%);27 injuries of cranial nerve occered in 21 pationts(33.87%),but only one permanent injury in them. Pathology reslts: 3 were malignant,others were benign;with 63 months follow-up ,no recurrence or metastasis occurred.Conclusion Preoperative superselective arteriography plus embolization may facilitate the surgical removal of CBT.Operation should be done within 48h.Internal shunts should not be used as a routine method. Histomorphology can not efficiently predict its biological behavior,so we should found a potent follow-up system.     

A multicenter review of carotid body tumour management.

OBJECTIVE: Carotid body tumour (CBT) is a rare but the most common form of head and neck paraganglioma (PGL). We present the biggest ever series on CBT in UK/EU discussing diagnostic challenges, surgical treatment and complications of surgical intervention. METHOD: A detailed proforma was designed and sent to all members of Joint Vascular Research Group (JVRG). Data of 95 patients was collected. Generic terms including carotid body tumour/s, or paraganglioma/s were used to search a variety of electronic database in order to get latest informations available in literature. RESULTS: A total of 95 patients were recorded in our data from 1979 to 2005. Mean age of presentation was 55 years. Incidence was higher in females. CBT was more common on right side (58%). 18% tumours were bilateral. Neck lump (98%) and pressure symptoms including cranial nerve deficits and pain were main presenting complaints. About 18% of tumours were familial. Only 4.2% were malignant. Duplex scan is the best investigation for diagnosis, though MRI, DSA and CT scan are important for preoperative assessment. Surgery is the treatment of choice. Stroke and cranial nerve injury constitute postoperative morbidity (35%) and mortality (1%). Incidence of postoperative cranial nerve deficit was about 19%. Combined ipsilateral and contralateral recurrence rate was 4.2%. CONCLUSION: CBT is a rare condition which needs surgical excision by experienced vascular surgeon. Surgical resection is associated with significant morbidity of 35% and mortality of 1%. Mostly CBT is benign but malignant forms are not uncommon.     

Oncoplastic Mammoplasty as a Strategy for Reducing Reconstructive Complications Associated with Postmastectomy Radiation Therapy

Given the high complication rates in patients who require radiation therapy (XRT) after mastectomy and immediate reconstruction, and the low local recurrence rates following neo‐adjuvant chemotherapy and breast conservation therapy, we sought to determine if using neo‐adjuvant chemotherapy and oncoplastic mammoplasty as an alternative to mastectomy and immediate reconstruction is an effective strategy for reducing complication rates in the setting of XRT. A prospectively maintained data base was queried for patients who received neo‐adjuvant chemotherapy and XRT between 2001 and 2010 and underwent either oncoplastic mammoplasty or mastectomy with immediate reconstruction. Rates of postoperative complications between groups were compared using Fisher's exact test. Outcomes from 37 patients who underwent oncoplastic mammoplasty were compared to 64 patients who underwent mastectomy with immediate reconstruction. Mean follow‐up was 33 months (range 4–116 months). Rates of postoperative complications, including unplanned operative intervention for a reconstructive complication (2.7% versus 37.5%, p < 0.001), skin flap necrosis (10.8% versus 29.7%, p = 0.05), and infection (16.2% versus 35.9, p = 0.04) were significantly higher in the mastectomy group. Overall, 45.3% of patients who underwent mastectomy developed at least one breast complication, compared to 18.9% of patients who underwent oncoplastic mammoplasty (p = 0.01). If XRT is indicated after mastectomy, attempts should be made to achieve breast conservation through the use of neo‐adjuvant therapy and oncoplastic surgery in order to optimize surgical outcomes. Breast conservation with oncoplastic reconstruction does not compromise oncologic outcome, but significantly reduces complications compared to postmastectomy reconstruction followed by XRT.     

Reconstruction modality based on the spare part concept for massive soft tissue defects following oncological hemipelvectomy

Background  Hemipelvectomy for massive malignancy can result in large soft tissue defects that cannot be reconstructed using conventional posterior flaps. For such cases, reconstruction methods, including a latissimus dorsi flap or a rectus abdominis myocutaneous flap, may be applied, resulting in donor site morbidity. Recent innovations in plastic surgery have resulted in the development of novel reconstruction modalities based on “the spare part concept,” applying tissues from amputated limbs. Methods  Five subjects with pelvic malignant tumors underwent hemipelvectomy with reconstruction using the spare part concept. Femoral artery-based myocutaneous flap and free fillet lower leg flap were used for three and two cases, respectively. The clinical results, including postoperative complications and oncological outcomes, were assessed. Results  The mean follow-up period was 43.2 months (range 12–94 months). No local recurrence was encountered in any cases throughout follow-up. As of the final follow-up, three patients remained alive and two patients were dead due to distant metastasis. Minor postoperative infection was observed in two cases. Conclusions  The femoral artery-based myocutaneous flap and the free fillet lower leg flap are both useful, safe options for reconstruction of the large defect following extensive hemipelvectomy for malignant bone and soft tissue tumors. The present data support the continued application of these flap reconstruction techniques based on the spare part concept.     

New predictors of complications in carotid body tumor resection

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.

Preoperative Biliary Drainage Increases Infectious Complications after Hepatectomy for Proximal Bile Duct Tumor Obstruction

Background  The role of preoperative biliary drainage before liver resection in jaundiced patients remains controversial. The objective of this study is to compare the perioperative outcome of liver resection for carcinoma involving the proximal bile duct in jaundiced patients with and without preoperative biliary drainage. Methods  Seventy-four consecutive jaundiced patients underwent hepatectomy for carcinoma involving the proximal bile duct from January 1989 to June 2006 and their data were retrospectively analyzed. Fourteen patients underwent biliary drainage before portal vein embolization and were excluded from the study. Thirty patients underwent biliary drainage before hepatectomy and 30 underwent liver resection without preoperative biliary drainage. All patients underwent resection of the extrahepatic bile duct. Results  Overall mortality and operative morbidity were similar in the two groups (3% vs. 10%, p = 0.612 and 70% vs. 63%, p = 0.583, respectively). The incidence of noninfectious complications was similar in the two groups. There was no difference in hospital stay between the two groups. Patients with preoperative biliary drainage had a significantly higher rate of infectious complications (40% vs. 17%, p = 0.044). At multivariate analysis, preoperative biliary drainage was the only independent risk factor for infectious complication in the postoperative course (RR = 4.411, 95%CI = 1.216-16.002, p = 0.024). Even considering patients with preoperative biliary drainage in whom the bilirubin level went below 5 mg/dl, the risk of infectious complications was higher compared with patients without biliary drainage (47.6% vs. 16.6%, p = 0.017). Conclusions  Overall mortality and morbidity after liver resection are not improved by preoperative biliary drainage in jaundiced patients. Prehepatectomy biliary drainage increases the incidence of infectious complications.     

Utilidad de la embolización vascular prequirúrgica de tumores renales con trombo tumoral en la vena renal izquierda

Introduction and objectivesPreoperative renal artery embolization (PRAE) for large renal masses may be performed prior to nephrectomy in order to simplify the procedure and reduce intraoperative bleeding. The objective of this work is to determine the role of PRAE on intraoperative bleeding and postoperative complications in left renal tumors with tumor thrombus limited to the left renal vein (level 0).Material and methodsRetrospective analysis to evaluate 46 patients who underwent left radical nephrectomy and thrombectomy for the treatment of renal cell carcinoma with level 0 tumor thrombus during the period 1990-2020. PRAE was limited to those cases in which surgical access to the main renal artery was presumed a priori difficult in the preoperative imaging study (n = 9; 19.6%). Intraoperative bleeding was estimated based on the perioperative transfusion rate, and postoperative complications were categorized according to the Clavien-Dindo classification. The Chi-squared test was used for comparisons. A multivariate analysis was performed to identify predictors of transfusion and complications.ResultsThere were no significant differences in the overall complication rate (11.1% vs. 32.4%, P = .19), major complication rate (0% vs.8.1%, P = .51), or transfusion rate (11.1% vs. 19%, P = .49) between both groups (PRAE vs. non-PRAE). In the multivariate analysis, PRAE did not behave as a predictor of complications (OR:0.11, 95%CI 0.01-2.86; P = .18) nor transfusion (OR:0.46, 95%CI 0.02-7.38;P = .58).ConclusionsIn our study on left renal cell carcinomas with level 0 tumor thrombus and difficult access to the main renal artery, PRAE was not associated with increased bleeding or postoperative complications, and it did not behave as an independent predictor of these variables. Therefore, it could be used as a preoperative maneuver to facilitate vascular management in selected cases.