Meta-Analysis of the Effects of Preoperative Embolization on the Outcomes of Carotid Body Tumor Surgery

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Magdy Samir ◽  
Tamer Abd ElWahab Abo Elezz ◽  
Peter Milad Mikahail ◽  
Mohamed Khaled Shafeek Bassam
Keyword(s):  
Postoperative Complications ◽  
Blood Loss ◽  
Surgical Resection ◽  
Carotid Body ◽  
Surgical Outcomes ◽  
Meta Analysis ◽  
Operation Time ◽  
Carotid Body Tumor ◽  
Preoperative Embolization ◽  
Tumor Surgery

ABSTRACT Background Carotid body tumors (CBTs) are situated at the bifurcation of the common carotid artery within the adventitia, and are reported to be the most common head and neck paragangliomas. Surgery is the gold standard for curative treatment of resectable CBTs and is recommended in otherwise healthy patients because of the risk of local complications related to tumor size and a small but definite risk of malignancy. Preoperative embolization has been shown to reduce potential intraoperative blood loss and provide the surgeon with greater ease and safety in excising the tumor, thus reducing the operation time and morbidity. However, other physicians have stated that although blood loss may be reduced after preoperative embolization, transfusion requirements are not affected, and that the embolization procedure adds a significant risk for stroke. Therefore, the purpose of the current study was to compare the surgical outcomes of patients undergoing CBT surgical resection with and without preoperative embolization. Aim To evaluate the need for preoperative embolization for the treatment of carotid body tumor. Methodology A meta-analysis study is done to compare the surgical outcomes of patients undergoing CBT surgical resection with and without preoperative embolization. Results Our meta-analysis for evaluation of the effects of preoperative embolization on the outcomes of carotid body tumor surgery, included (14) studies with a total number of patients (n = 477).The results of these studies showed no statistically significant difference between preoperative embolization group and non embolization group in carotid body surgery for (blood loss & operation time). Preoperative embolization did not reduce risk of postoperative complications. Conclusion Preoperative embolization shows no statistically significant reducing in blood loss and operation time, also embolization does not decrease incidence of postoperative complications. It seems that embolization should not be a routine part of carotid body tumor surgery especially with the known potential risks and complications of this procedure .

Impact of preoperative embolization on the outcomes of carotid body tumor surgery: A meta-analysis and review of the literature

Head & Neck ◽  
2016 ◽  
Vol 38 (S1) ◽  
pp. E2386-E2394 ◽  
Author(s):  
Sara Abu-Ghanem ◽  
Moshe Yehuda ◽  
Narin Nard Carmel ◽  
Avraham Abergel ◽  
Dan M. Fliss
Keyword(s):  
Carotid Body ◽  
Meta Analysis ◽  
Carotid Body Tumor ◽  
Preoperative Embolization ◽  
Tumor Surgery ◽  
Review Of The Literature

Role of Preoperative Embolization in Carotid Body Tumor Surgery: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 129 ◽  
pp. 503-513.e2 ◽  
Author(s):  
Pavlos Texakalidis ◽  
Nektarios Charisis ◽  
Stefanos Giannopoulos ◽  
Dimitrios Xenos ◽  
Leonardo Rangel-Castilla ◽  
...  
Keyword(s):  
Systematic Review ◽  
Carotid Body ◽  
Meta Analysis ◽  
Carotid Body Tumor ◽  
Preoperative Embolization ◽  
Tumor Surgery

Interventional embolization of giant thoracic tumors before surgical resection

2013 ◽  
Vol 54 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Feng-Yong Liu ◽  
Mao-Qiang Wang ◽  
Qing-Sheng Fan ◽  
Feng Duan ◽  
Zhi-Jun Wang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Loss ◽  
Polyvinyl Alcohol ◽  
Surgical Resection ◽  
Efficient Method ◽  
Preoperative Embolization ◽  
Patient Records ◽  
Operative Field ◽  
Feeding Vessels ◽  
Pva Particles

Background Preoperative embolization of tumors is a well-established procedure that has been successfully applied in various clinical situations. Preoperative embolization can reduce the vascularity of tumors resulting in a clearer operative field, less difficult dissection, decreased blood loss, and, in some cases, a decrease in tumor size. However, few studies have been conducted regarding the preoperative embolization of giant thoracic tumors. Purpose To examine the effectiveness and safety of interventional embolization of giant thoracic tumors before surgical resection. Material and Methods A total of 14 consecutive patients with giant thoracic tumors received angiography and the feeding arteries of the tumors were embolized using polyvinyl alcohol (PVA) particles and gelatin sponges 1 day before surgical resection. The patient records were retrospectively reviewed and data regarding diagnoses, embolization, and surgical resection were recorded. Results Angiography revealed the feeding arteries of the tumors to be characterized by multiple branches and thickened vessel trunks with abnormal distal branches superimposed of the tumor shadow. Embolization was successfully without complications in all patients, and all feeding vessels of each tumor were occluded. Embolization reduced the severity of bleeding during surgery and decreased the difficulty of resection of the tumor. No intraoperative or postoperative complications occurred. Conclusion Interventional embolization is a safe and efficient method to facilitate the surgical resection of giant thoracic tumors.

Preoperative Angiography and Transarterial Embolization in the Management of Carotid Body Tumor: A Single-Center, 10-Year Experience

Neurosurgery ◽  
2010 ◽  
Vol 67 (4) ◽  
pp. 941-948 ◽  
Author(s):  
Jiaping Li ◽  
Shenming Wang ◽  
Chishing Zee ◽  
Jianyong Yang ◽  
Wei Chen ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Carotid Body ◽  
Operation Time ◽  
Class Ii ◽  
Preoperative Embolization ◽  
Intraoperative Blood Loss ◽  
Class Iii ◽  
Group I ◽  
Group Ii

Abstract BACKGROUND: Sixty percent of paragangliomas are located unilaterally at the carotid bifurcation. These are referred to as carotid body tumors (CBTs). OBJECTIVE: To present our 10-year experience in the management of patients with CBTs, and to evaluate the efficacy of angiography and preoperative embolization technique in this retrospective study. METHODS: Sixty-two patients with surgically removed CBTs (Shamblin class II and III), were divided into two groups. Group I, the preoperative embolization group, included 33 patients with 11 class II lesions and 25 class III lesions. Group II, the group that had surgery only, without preoperative embolization, included 29 patients with 9 class II lesions and 21 class III lesions. Comparisons were made between the groups in terms of mean intraoperative blood loss, mean operation time, mean postoperative hospital stay, and clinical complications. RESULTS: In group I, post-embolization angiography demonstrated complete tumor devascularization in 25 (76%) lesions and partial devascularization in 11 (24%) lesions. All but 1 (2%) lesion were completely excised. Mean intraoperative blood loss, mean operation time, and mean hospital stay were 354.8 ± 334.4 mL, 170.3 ± 75.4 min, 8.0 ± 2.1days in group I and 656.4 ± 497.4 mL, 224.6 ± 114.0 min, 9.5 ± 3.5days in group II, respectively. In group II, 27 lesions (91%) were completely removed. The transient ischemic attack (TIA) and cranial nerve injury incidence rates were 10.3% and 13.8% in group II and only 3% for TIA in group I. CONCLUSION: These results suggest angiography is highly valuable for the diagnosis of CBT. Preoperative selective embolization of CBT is an effective and safe adjunct for surgical resection, especially for Shamblin class II and III tumors.

scholarly journals The effect of preoperative embolization on surgical outcomes for carotid body tumor resection

2021 ◽  
Vol 9 ◽  
pp. 205031212110052
Author(s):  
Robin Osofsky ◽  
Ross Clark ◽  
Jaideep Das Gupta ◽  
Nathan Boyd ◽  
Garth Olson ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Carotid Body ◽  
Surgical Outcomes ◽  
Cranial Nerve ◽  
Operative Time ◽  
Tumor Resection ◽  
Carotid Body Tumor ◽  
Preoperative Embolization ◽  
Estimated Blood Loss ◽  
Cranial Nerve Injury

Objective: Compare the effects of preoperative embolization for carotid body tumor resection on surgical outcomes to carotid body tumor resections without preoperative embolization. Methods: Single-center retrospective review of all consecutive patients who underwent carotid body tumor resection from 2001 to 2019. Surgical outcomes with emphasis on operative time (estimated blood loss and cranial nerve injury) of patients undergoing carotid body tumor resection following preoperative embolization were compared to those undergoing resection alone using unpaired Student’s t-test and Fisher’s exact test. Results: Forty-six patients (15% male, mean age 50 ± 15 years) underwent resection of 49 carotid body tumors. Patients undergoing preoperative embolization ( n = 20 (40%)) had larger mean tumor size (4.0 ± 0.7 vs 3.2 ± 1 cm, p = 0.006), increased Shamblin II/III tumor classification (18 (90%) vs 22 (76%), p < 0.001), operative time (337 ± 195 vs 199 ± 100 min, p = 0.004), and cranial nerve injuries overall (8 (40%) vs 2 (10%), p = 0.01) compared to patients undergoing resection without preoperative embolization ( n = 29 (60%)). In subgroup analysis of Shamblin II/III classification tumors ( n = 40), preoperative embolization ( n = 18) was associated with increased tumor size (4.1 ± 0.6 vs 3.5 ± 0.9 cm, p = 0.01), operative time (351 ± 191 vs 244 ± 105 min, p = 0.02), and cranial nerve injury overall (8 (44%) vs 2 (9%), p = 0.03) compared to resections alone ( n = 19). In further subgroup analysis of large (⩾ 3 cm) tumors ( n = 37), preoperative embolization ( n = 18) was associated with increased operative time (350 ± 191 vs 198 ± 99 min, p = 0.006) and cranial nerve injury overall (8 (44%) vs 2 (11%), p = 0.03) compared to resections alone ( n = 19). There were no significant differences in estimated blood loss, transfusion requirement, or hematoma formation between any of the embolization and non-embolization subgroups. Conclusion: After controlling for tumor Shamblin classification and size, carotid body tumor resections following preoperative embolization were associated with increased operative time and inferior surgical outcomes compared to those tumors undergoing resection alone. Nonetheless, such results remain susceptible to the confounding effects of individual tumor characteristics often used in the decision to perform preoperative embolization, underscoring the need for prospective studies evaluating the utility of preoperative embolization for carotid body tumors.

scholarly journals Preoperative Embolization in Carotid Body Tumor Surgery—Benefit or Risk?

2020 ◽  
Vol 72 (1) ◽  
pp. e65
Author(s):  
Tina Cohnert ◽  
Johanna Muhlsteiner ◽  
Gregor Siegl ◽  
Hannes Deutschmann
Keyword(s):  
Carotid Body ◽  
Carotid Body Tumor ◽  
Preoperative Embolization ◽  
Tumor Surgery

scholarly journals A Meta-Analysis of Robotic Surgery in Endometrial Cancer: Comparison with Laparoscopy and Laparotomy

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Jia Wang ◽  
Xiaomao Li ◽  
Haotian Wu ◽  
Yu Zhang ◽  
Fei Wang
Keyword(s):  
Endometrial Cancer ◽  
Robotic Surgery ◽  
Postoperative Complications ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Lymph Nodes ◽  
Meta Analysis ◽  
Operation Time ◽  
Surgical Staging ◽  
Estimated Blood Loss

Background. The safety and effectiveness of robotic surgery are evaluated by comparing perioperative outcomes with laparoscopy and laparotomy in endometrial cancer. Method. PubMed, MEDLINE, Embase, Cochrane, and other databases were searched for eligible studies up to April 2019. Studies that compared robotic surgery with laparoscopy or laparotomy in surgical staging of endometrial cancer were included. The pooled odds ratio and weighted mean difference were calculated using a random-effects or a fixed-effects model to summarize the results. Results. Twenty-seven articles were ultimately included, with one randomized controlled trial and 26 observational studies. A total of 6568 patients were included. Meta-analysis showed that robotic surgery had less estimated blood loss (P<0.001), blood transfusion (P=0.04), intraoperative complications (P=0.001), and conversion to open surgery (P=0.001), and a shorter hospital stay (P=0.001), but had a longer operation time (P=0.04) in surgical staging of endometrial cancer compared with laparoscopy. There were no significant differences in postoperative complications, the total number of lymph nodes harvested, the number of pelvic lymph nodes harvested, and the number of para-aortic lymph nodes harvested between techniques. Robotic surgery had a longer operation time (P=0.008), less estimated blood loss (P<0.001), blood transfusion (P<0.001), and postoperative complications (P<0.001), and a shorter hospital stay (P<0.001) compared with laparotomy. There were no significant differences in other variables between techniques. Conclusion. Robotic surgery is a safer surgical approach than laparoscopy and laparotomy in surgical staging of endometrial cancer, with less estimated blood loss, blood transfusion, and conversion, and the same number of lymph nodes harvested.

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