Bilateral carotid body tumor management: tips, tricks, strategies, and problems.

IF 1.9 4区 医学 Q2 OTORHINOLARYNGOLOGY Current Opinion in Otolaryngology & Head and Neck Surgery Pub Date : 2025-04-01 Epub Date: 2025-01-29 DOI:10.1097/MOO.0000000000001035
Cesare Piazza, Claudia Montenegro, Vittorio Rampinelli
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Abstract

Purpose of review: Carotid body tumors (CBTs) are rare neuroendocrine tumors with an annual incidence of 1 : 30 000. Bilateral carotid body tumors (BCBTs) account for 3-5% of all CBTs and are more frequently linked to familial syndromes and potential malignancy. BCBT management is still not universally standardized and depends on multiple factors, including patient's age, risk of malignancy, location, growth rate, size, and related Shamblin and Mehanna classifications.

Recent findings: Options of treatment include active surveillance, external beam radiation, and surgery. Surgery is the first-choice treatment, but it may not always be performed especially in elderly patients. Simultaneous BCBT resection is not suggested due to high intra-operative and postoperative risks. The decision to operate on the larger or smaller tumor first is still debated. Whenever feasible, treatment of the larger tumor first to reduce the tumor burden should be preferred but with higher risks of neurovascular injury. Conversely, starting with the smaller tumor first offers a lower risk at initial surgery but may complicate the management of the larger tumor later.

Summary: Surgery for BCBTs, whenever feasible, remains the most indicated treatment but poses a significant risk of neurovascular complications. Resection of the larger, often more symptomatic, and potentially problematic or malignant tumor, reduces the overall disease burden and mitigates risks of rapid progression but involves a higher immediate complication hazard. Multidisciplinary evaluation is essential for balancing surgical risks and long-term outcomes, prioritizing neurovascular preservation and reducing morbidity.

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审查目的:颈动脉体肿瘤(CBT)是一种罕见的神经内分泌肿瘤,年发病率为 1 :30 000.双侧颈动脉体肿瘤(BCBTs)占所有 CBTs 的 3-5%,更常见于家族性综合征和潜在的恶性肿瘤。双侧颈动脉体肿瘤的治疗仍未普遍标准化,取决于多种因素,包括患者的年龄、恶性风险、位置、生长速度、大小以及相关的 Shamblin 和 Mehanna 分类:治疗方法包括积极监测、体外放射和手术。手术是首选治疗方法,但不一定都能实施,尤其是老年患者。由于术中和术后风险较高,不建议同时进行 BCBT 切除术。关于先对较大肿瘤还是较小肿瘤进行手术的决定仍存在争议。在可行的情况下,应首选先治疗较大的肿瘤以减轻肿瘤负担,但神经血管损伤的风险较高。反之,先治疗较小的肿瘤在初始手术时风险较低,但可能会使以后较大肿瘤的治疗复杂化。摘要:只要可行,手术治疗 BCBT 仍是最适用的治疗方法,但会带来神经血管并发症的巨大风险。切除较大的、通常症状较重、有潜在问题的肿瘤或恶性肿瘤,可减轻总体疾病负担,降低快速进展的风险,但涉及较高的直接并发症风险。多学科评估对于平衡手术风险和长期效果、优先保留神经血管和降低发病率至关重要。
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来源期刊
CiteScore
2.90
自引率
0.00%
发文量
96
审稿时长
6-12 weeks
期刊介绍: Current Opinion in Otolaryngology & Head and Neck Surgery is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With eleven disciplines published across the year – including maxillofacial surgery, head and neck oncology and speech therapy and rehabilitation – every issue also contains annotated references detailing the merits of the most important papers.
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