Surgical Evolution and Long-Term Control in Carotid Body Tumors. An Institutional Experience over Two Decades

Carotid body tumors (CBTs) are rare neoplasms for which universally accepted diagnostic and management guidelines are lacking, complicating the development of standardized treatment pathways. We present a 22-year single-center experience that longitudinally evaluates operative strategy, perioperative risk mitigation, and long-term outcomes, and we describe an institutional care bundle derived from this experience.

We conducted a retrospective cohort study with prospective follow-up of all patients who underwent open resection for CBT at a tertiary vascular surgery unit between June 30, 2003 and January 28, 2025 according to STROBE criteria. Demographic, imaging, operative, histopathologic, and follow-up data were extracted from electronic medical records. Tumors were staged according to the Shamblin classification. The primary endpoint was the assessment of institutional practice with respect to perioperative morbidity (including cranial nerve injury and vascular complications), mortality, recurrence, and long-term oncologic status. Subgroup analyses were also performed to assess differences between early and later period of our practice. Categorical variables were compared using Fisher's exact test. A P-value <0.05 was considered statistically significant.

Seventy-four patients (81 tumors) (mean age 53 years, range 21-89; 62.2% female) underwent 81 procedures: 77 (95.1%) complete resections, 2 (2.5%) partial resections, and 2 (2.5%) embolization alone. Tumor diameter ranged from 15 to 60 mm (mean 32 mm). By Shamblin grade, 3 tumors (3.7%) were type I, 53 (65.4%) were type II, and 25 (30.9%) were type III. Preoperative embolization was performed in 28 cases (34.6%). Two patients experienced a transient ischemic attack during embolization; their resections were deferred by 35 and 47 days, respectively. Internal carotid artery resection with reconstruction was required in 2 patients. Early postoperative complications occurred in 15 (18.9%) interventions. These comprised dysphagia in 5 patients (6.3%), dysphonia in 5 patients (6.3%), wound hematoma requiring reoperation in 2 patients (2.5%), 2 (2.5%) complete Horner syndrome, and one (1.7%) episode of aspiration pneumonia. Subgroup analyses were also performed to assess differences between early (2003-2013) and later (2014-2025) period of our practice. Reinterventions for bleeding were performed both in the early period but overall, there was no statistical difference between the 2 period in terms of complications (P = 1). Additionally comparative analysis was performed according to the shambling type (Shambling I/II versus III) to detect difference in clinical outcomes but no statistical difference were found when comparing overall complications (P = 0.723) nor vascular procedures (P = 0.698) probably due to the small number of events. There were no perioperative or follow-up deaths. At a mean follow-up of 83.8 months (range 1-271), one local recurrence was documented and managed conservatively; no metastatic disease was identified.

This series describes temporal changes in preoperative imaging, selective embolization, and dissection techniques and their association with outcomes including nerve morbidity, vascular complications, and oncologic control. In this high-volume tertiary practice, open surgical resection combined with selective preoperative embolization and vascular reconstruction when indicated was associated with low rates of permanent neurologic morbidity and durable oncologic outcomes.