Carotid chemodectomas: long-term results of subadventitial resection with deliberate external carotid resection.
The aim of this study was to evaluate the short-term and long-term results of the subadventitial resection of carotid chemodectomas and to validate the importance of deliberate resection of the external carotid artery (ECA). From 1981 to 2006, 39 carotid chemodectomas of the carotid bifurcation or of the neighboring nerves were operated on in our department. There were 14 men and 22 women, with a mean age 44.4 +/- 5 (range 21-78) years. One of these operations was a redo surgery for local recurrence. One female patient presented with a bilateral tumor. Two tumors were secreting catecholamines. All these tumors affected the carotid body; 10 of them were also affecting the vagus nerve, and one among these last 10 affected the sympathetic nerve as well. In 11 cases, the tumor had spread into the subparotidal space and, in one case, into the skull. In two cases, the tumor had been revealed by hemispheric ischemia and in every case by tumoral syndrome. All the patients were followed up by clinical examination, duplex scan, or computed tomographic scan until the end of 2006. In 38 cases, complete resection was performed; an incomplete resection was performed in one case with cranial invasion. Under general anesthesia, and most of the time without pharmaceutical preparation, surgery consisted of a deliberate sacrifice of the ECA followed by subadventitial resection of the tumor. In one case, a previous embolization had been carried out to facilitate the cleavage, which in fact rendered it more complicated. In 22 cases, resection concerned the ECA; in seven cases, it concerned the common carotid artery and the internal carotid artery (ICA): in seven cases the superior laryngeal nerve, in nine cases the vagus nerve, in five cases the sympathetic nerve, and in four cases the jugular vein. In 13 cases, node clearing was associated. In 20 cases, an additional vascular procedure was performed: nine dilatations for spasm of the ICA, five autogenous vein grafts, two prosthetic bypasses, and one endarterectomy associated with a patch angioplasty. All patients were followed up until 2006. At 3 months, the observed complications were the sequelae of a homolateral hemispheric accident due to thrombosis of a vein graft, eight peripheral facial nerve palsies, 12 vocal palsies, seven Claude Bernard-Horner (CBH) syndromes, eight palatal paralyses, and 10 nociceptive pains. Some of these complications did persist: nine vocal cord paralyses that were successfully treated by speech therapy, three mild CBH syndromes, and nociceptive pains in 6% of the cases (15.4%), incapacitating in one case. With a follow-up of 115 +/- 27 (range 1-298) months, three local recurrences were recorded at 6 and 10 years. In two cases, local recurrence occurred when initial resection of the ECA had not been performed. Two patients presented with a contralateral lesion, at 12 and 16 years, respectively. At 40 months, one patient had to be reoperated on for an atheromatous stenosis. At 51 months, a female patient's death was not related to the operation. Subadventitial resection of carotid body tumors with deliberate resection of the ECA is a simple and efficient procedure. It is the preferential treatment for these slow-growing localized tumors.
Koskas
Fabien
F
Department of Vascular Surgery, Pitié-Salpétriêre University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France. fabien.koskas@psl.aphp.fr
Vignes
Stéphane
S
Khalil
Issa
I
Koskas
Isabelle
I
Dziekiewicz
Myrek
M
Elmkies
Frédéric
F
Lamas
Georges
G
Kieffer
Edouard
E
D000328:Adult; D000368:Aged; D017130:Angioplasty; D019917:Blood Vessel Prosthesis Implantation; D002342:Carotid Artery, External / Q000473:pathology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery; D002345:Carotid Body Tumor / Q000473:pathology / Q000601:surgery*; D003238:Connective Tissue / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000601:surgery; D007823:Laryngeal Nerves / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D013564:Sympathetic Nervous System / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014630:Vagus Nerve / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014680:Veins / Q000637:transplantation; D055815:Young Adult