A meta-analysis on the surgical management of paraganglioma of the carotid body per Shamblin class.

A meta-analysis on the surgical management of paraganglioma of the carotid body per Shamblin class.

Clin Otolaryngol. 2018 Apr 15;:

Authors: Jansen TTG, Marres HAM, H A M Kaanders J, Kunst HPM

Abstract
OBJECTIVE: The aim of the current study is to evaluate the risk associated with different types of surgery for carotid body paraganglioma of different Shamblin class. A meta-analysis was conducted to evaluate per tumour class, the local control, cranial nerve damage and complication rates of different techniques using internal carotid artery (ICA) and external carotid artery (ECA) ligation, clamping or bypassing, as well as the cranio-caudal versus caudo-cranial techniques.
DESIGN: A meta-analysis is conducted after a systematic search in PubMed and the Cochrane library, in accordance with the PRISMA guidelines.
MAIN OUTCOME MEASURES: local control, cranial nerve damage, complications, function recovery.
RESULTS: Out of 3565 articles, 27 were selected. The overall quality of evidence of studies was low. Cranial nerve damage (3%, 17% and 39%) and complication rates (0%, 1%, 10%) were significantly related to Shamblin class (class 1, 2, 3, respectively, p < 0.01). For class 3 tumours an increased risk of complications was found associated with routine ICA manipulation/reconstruction (RR 3.12 with a 95% CI of 1.29-7.59), as well as a trend towards enhanced risk of routine ECA ligation (RR 3.48 with a 95% CI of 0.88-13.81).
CONCLUSIONS: For class 1 and 2 tumours surgery seems a viable treatment option. For class 3 tumours, morbidity in terms of cranial nerve deficit and complications is considerable, particularly the use of ICA manipulation/reconstruction and potentially ECA ligation seems to be accompanied by high a stroke incidence. This article is protected by copyright. All rights reserved.

PMID: 29656606 [PubMed - as supplied by publisher]

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