Proposed modification to the Shamblin's classification of carotid body tumors: A single-center retrospective experience of 116 tumors |
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| Affiliation: | 1. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden;2. Division of Surgery, Danderyd Hospital, Stockholm, Sweden;3. Department of Diagnostic Radiology, Karolinska University Hospital, Stockholm, Sweden;4. Department of Pelvic Cancer, GI Oncology and Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden;1. Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy;2. Division of Medical Oncology, San Giovanni-Addolorata Hospital, Rome, Italy;3. IRCCS Policlinico di Sant’Orsola, University of Bologna, Bologna, Italy;4. IRCCS Ospedale Policlinico San Martino, Breast Unit, and Department of Internal Medicine and Medical Specialties (DIMI), Genova, Italy;5. Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands;6. Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA;7. Department of Oncological Surgery, Humanitas Catanese Center of Oncology, Catania, Italy;8. Breast Centre, San Giovanni-Addolorata Hospital, Rome, Italy;1. Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, University Medical Center Halle, Halle, Germany;2. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany;3. Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland;4. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany;5. Institute for Pathology, Industriestr. 11c, 67063, Ludwigshafen, Germany;1. Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands;2. Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands;3. Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands;4. Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Germany;5. Maria Sklodowska-Curie National Research Institute of Oncology, Department of Soft Tissue/Bone Sarcoma and Melanoma, Warsaw, Poland;6. The Royal Marsden NHS Foundation Trust / Institute of Cancer Research, London, UK;7. Medical Oncology Department, Virgen del Rocio University Hospital, Seville, Spain;8. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;9. Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium;10. Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK;11. Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands;12. Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands;13. Department of Surgical Oncology, Antoni van Leeuwenhoek – Netherlands Cancer Institute, Amsterdam, the Netherlands;14. Department of Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands;15. European School of Soft Tissue Sarcoma Surgery, Amsterdam, the Netherlands |
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| Abstract: | ObjectivesCarotid body tumors (CBTs) are rare head and neck neoplasms, we aimed to propose a modification to the Shamblin's classification of CBTs.Materials and methodsThis retrospective study included 105 patients (116 CBTs) operated at our institution from March 2013 to July 2020. CBTs were divided by a modified Shamblin's classification into five subtypes (type I–V) based on the radiographic features. Correlations between modified classification and intraoperative bleeding, internal carotid artery (ICA) bypass and postoperative neural complications, as main outcomes, as well as other outcomes were analyzed.ResultsSurgeries for type V and type I CBTs had the most (median: 700 ml, IQR: 375–1575 ml) and least (median: 20 ml, IQR: 20–50 ml) bleeding, respectively. Intraoperatively, ICA bypass was needed in 41.7% (10/24) type V, 18.2% (8/44) type IV and 5.9% (1/17) type III lesions, but not in other subtypes (p = .001). Postoperatively, overall cranial nerve deficits (CND) were found most frequently in type V tumors (17/24, 70.8%) (p = .016). Permanent CND were found in 33.3% (8/24) type V and 4.5% (2/44) type IV lesions, but not in other subtypes (p = .001). Other outcomes including external carotid artery ligation, operation time, blood transfusion, postoperative intensive unit care and postoperative hospitalization also showed significant difference among different subtypes. Patients recovered uneventfully during a follow-up of 23.5 ± 16.2 months except for one ipsilateral recurrence at 42 months after surgery.ConclusionsThe modified classification was correlated with surgical outcomes of CBTs and will be helpful for making surgical plans. |
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| Keywords: | Carotid body tumor Clinical classification Surgery Vascular bypass Neurological complications |
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