New predictors of complications in carotid body tumor resection.

Autor:	Kim GY; University of Michigan Health System, Ann Arbor, Mich; UCLA Health System, Los Angeles, Calif., Lawrence PF; UCLA Health System, Los Angeles, Calif. Electronic address: pflawrence@mednet.ucla.edu., Moridzadeh RS; UCLA Health System, Los Angeles, Calif; NYU Langone Medical Center, New York, NY., Zimmerman K; Mayo Medical School, Rochester, Minn., Munoz A; Universidad Nacional de Colombia, Bogotá, Colombia., Luna-Ortiz K; Instituto Nacional de Cancerologia, Tlalpan, Mexico., Oderich GS; Mayo Clinic, Rochester, Minn., de Francisco J; Clinica del Country, Bogotá, Colombia., Ospina J; Clinica del Country, Bogotá, Colombia., Huertas S; Universidad Nacional de Colombia, Bogotá, Colombia., de Souza LR; Mayo Clinic, Rochester, Minn., Bower TC; Mayo Clinic, Rochester, Minn., Farley S; UCLA Health System, Los Angeles, Calif., Gelabert HA; UCLA Health System, Los Angeles, Calif., Kret MR; Colorado Cardiovascular Surgical Associates, Denver, Colo., Harris EJ Jr; Stanford University School of Medicine, Stanford, Calif., De Caridi G; University of Messina, Messina, Italy., Spinelli F; University of Messina, Messina, Italy., Smeds MR; University of Arkansas for Medical Sciences, Little Rock, Ark., Liapis CD; Athens Medical Center, Athens, Greece., Kakisis J; University of Athens, Athens, Greece., Papapetrou AP; Athens Medical Center, Athens, Greece., Debus ES; University Hospital Hamburg-Eppendorf, Hamburg, Germany., Behrendt CA; University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Kleinspehn E; University Clinics Hamburg-Eppendorf, Hamburg, Germany., Horton JD; NYU Langone Medical Center, New York, NY; Medical University of South Carolina, Charleston, SC., Mussa FF; NYU Langone Medical Center, New York, NY; Columbia University, New York, NY., Cheng SWK; The University of Hong Kong, Queen Mary Hospital, Hong Kong., Morasch MD; Billings Clinic, Billings, Mont., Rasheed K; University of Rochester Medical Center, Rochester, NY., Bennett ME; Houston Methodist Hospital, Houston, Tex., Bismuth J; Houston Methodist Hospital, Houston, Tex., Lumsden AB; Houston Methodist Hospital, Houston, Tex., Abularrage CJ; The Johns Hopkins Hospital, Baltimore, Md., Farber A; Boston Medical Center, Boston, Mass.
Jazyk:	angličtina
Zdroj:	Journal of vascular surgery [J Vasc Surg] 2017 Jun; Vol. 65 (6), pp. 1673-1679.
DOI:	10.1016/j.jvs.2016.12.124
Abstrakt:	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. Methods: Patients who underwent CBT resection between 2004 and 2014 were studied using a standardized, multi-institutional database. Demographic, perioperative, and outcomes data were collected. CBT measurements were determined from computed tomography, magnetic resonance imaging, and ultrasound examination. Results: There were 356 CBTs resected in 332 patients (mean age, 51 years; 72% female); 32% were classified as Shamblin I, 43% as Shamblin II, and 23% as Shamblin III. The mean DTBOS was 3.3 cm (standard deviation [SD], 2.1; range, 0-10), and the mean tumor volume was 209.7 cm ³ (SD, 266.7; range, 1.1-1642.0 cm ³ ). The mean estimated blood loss (EBL) was 257 mL (SD, 426; range, 0-3500 mL). Twenty-four percent of patients had cranial nerve injuries. The most common cranial nerves injured were the hypoglossal (10%), vagus (11%), and superior laryngeal (5%) nerves. Both Shamblin grade and DTBOS were statistically significantly correlated with EBL of surgery and cranial nerve injuries, whereas tumor volume was statistically significantly correlated with EBL. The logistic model for predicting blood loss and cranial nerve injury with all three variables-Shamblin, DTBOS, and volume (R ² = 0.171, 0.221, respectively)-was superior to a model with Shamblin alone (R ² = 0.043, 0.091, respectively). After adjusting for Shamblin grade and volume, every 1-cm decrease in DTBOS was associated with 1.8 times increase in risk of >250 mL of blood loss (95% confidence interval, 1.25-2.55) and 1.5 times increased risk of cranial nerve injury (95% confidence interval, 1.19-1.92). Conclusions: This large study of CBTs demonstrates the value of preoperatively determining tumor dimensions and how far the tumor is located from the base of the skull. DTBOS and tumor volume, when used in combination with the Shamblin grade, better predict bleeding and cranial nerve injury risk. Furthermore, surgical resection before expansion toward the base of the skull reduces complications as every 1-cm decrease in the distance to the skull base results in 1.8 times increase in >250 mL of blood loss and 1.5 times increased risk of cranial nerve injury. (Copyright © 2017. Published by Elsevier Inc.)
Databáze:	MEDLINE
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