New predictors of complications in carotid body tumor resection

Gloria Y. Kim, Peter F. Lawrence, Rameen S. Moridzadeh, Kate Zimmerman, Alberto Munoz, Kuauhyama Luna-Ortiz, Gustavo Oderich, Juan de Francisco, Jorge Ospina, Santiago Huertas, Leonardo R. de Souza, Thomas C. Bower, Steven Farley, Hugh A. Gelabert, Marcus R. Kret, E. John Harris, Giovanni De Caridi, Francesco Spinelli, Matthew R. Smeds, Christos D. LiapisJohn Kakisis, Anastasios P. Papapetrou, Eike S. Debus, Christian A. Behrendt, Edgar Kleinspehn, Joshua D. Horton, Firas F. Mussa, Stephen W.K. Cheng, Mark D. Morasch, Khurram Rasheed, Matthew E. Bennett, Jean Bismuth, Alan B. Lumsden, Christopher J. Abularrage, Alik Farber

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective This study examined the relationship between two new variables, tumor distance to base of skull (DTBOS) and tumor volume, with complications of carotid body tumor (CBT) resection, including bleeding and cranial nerve injury. Methods Patients who underwent CBT resection between 2004 and 2014 were studied using a standardized, multi-institutional database. Demographic, perioperative, and outcomes data were collected. CBT measurements were determined from computed tomography, magnetic resonance imaging, and ultrasound examination. Results There were 356 CBTs resected in 332 patients (mean age, 51 years; 72% female); 32% were classified as Shamblin I, 43% as Shamblin II, and 23% as Shamblin III. The mean DTBOS was 3.3 cm (standard deviation [SD], 2.1; range, 0-10), and the mean tumor volume was 209.7 cm3 (SD, 266.7; range, 1.1-1642.0 cm3). The mean estimated blood loss (EBL) was 257 mL (SD, 426; range, 0-3500 mL). Twenty-four percent of patients had cranial nerve injuries. The most common cranial nerves injured were the hypoglossal (10%), vagus (11%), and superior laryngeal (5%) nerves. Both Shamblin grade and DTBOS were statistically significantly correlated with EBL of surgery and cranial nerve injuries, whereas tumor volume was statistically significantly correlated with EBL. The logistic model for predicting blood loss and cranial nerve injury with all three variables—Shamblin, DTBOS, and volume (R2 = 0.171, 0.221, respectively)—was superior to a model with Shamblin alone (R2 = 0.043, 0.091, respectively). After adjusting for Shamblin grade and volume, every 1-cm decrease in DTBOS was associated with 1.8 times increase in risk of >250 mL of blood loss (95% confidence interval, 1.25-2.55) and 1.5 times increased risk of cranial nerve injury (95% confidence interval, 1.19-1.92). Conclusions This large study of CBTs demonstrates the value of preoperatively determining tumor dimensions and how far the tumor is located from the base of the skull. DTBOS and tumor volume, when used in combination with the Shamblin grade, better predict bleeding and cranial nerve injury risk. Furthermore, surgical resection before expansion toward the base of the skull reduces complications as every 1-cm decrease in the distance to the skull base results in 1.8 times increase in >250 mL of blood loss and 1.5 times increased risk of cranial nerve injury.

Original languageEnglish (US)
Pages (from-to)1673-1679
Number of pages7
JournalJournal of Vascular Surgery
Volume65
Issue number6
DOIs
StatePublished - Jun 1 2017

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Carotid Body Tumor
Cranial Nerve Injuries
Skull Base
Tumor Burden
Confidence Intervals
Laryngeal Nerves
Hemorrhage
Neoplasms
Cranial Nerves
Logistic Models
Tomography
Magnetic Resonance Imaging
Demography
Databases

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Kim, G. Y., Lawrence, P. F., Moridzadeh, R. S., Zimmerman, K., Munoz, A., Luna-Ortiz, K., ... Farber, A. (2017). New predictors of complications in carotid body tumor resection. Journal of Vascular Surgery, 65(6), 1673-1679. https://doi.org/10.1016/j.jvs.2016.12.124

New predictors of complications in carotid body tumor resection. / Kim, Gloria Y.; Lawrence, Peter F.; Moridzadeh, Rameen S.; Zimmerman, Kate; Munoz, Alberto; Luna-Ortiz, Kuauhyama; Oderich, Gustavo; de Francisco, Juan; Ospina, Jorge; Huertas, Santiago; de Souza, Leonardo R.; Bower, Thomas C.; Farley, Steven; Gelabert, Hugh A.; Kret, Marcus R.; Harris, E. John; De Caridi, Giovanni; Spinelli, Francesco; Smeds, Matthew R.; Liapis, Christos D.; Kakisis, John; Papapetrou, Anastasios P.; Debus, Eike S.; Behrendt, Christian A.; Kleinspehn, Edgar; Horton, Joshua D.; Mussa, Firas F.; Cheng, Stephen W.K.; Morasch, Mark D.; Rasheed, Khurram; Bennett, Matthew E.; Bismuth, Jean; Lumsden, Alan B.; Abularrage, Christopher J.; Farber, Alik.

In: Journal of Vascular Surgery, Vol. 65, No. 6, 01.06.2017, p. 1673-1679.

Research output: Contribution to journalArticle

Kim, GY, Lawrence, PF, Moridzadeh, RS, Zimmerman, K, Munoz, A, Luna-Ortiz, K, Oderich, G, de Francisco, J, Ospina, J, Huertas, S, de Souza, LR, Bower, TC, Farley, S, Gelabert, HA, Kret, MR, Harris, EJ, De Caridi, G, Spinelli, F, Smeds, MR, Liapis, CD, Kakisis, J, Papapetrou, AP, Debus, ES, Behrendt, CA, Kleinspehn, E, Horton, JD, Mussa, FF, Cheng, SWK, Morasch, MD, Rasheed, K, Bennett, ME, Bismuth, J, Lumsden, AB, Abularrage, CJ & Farber, A 2017, 'New predictors of complications in carotid body tumor resection', Journal of Vascular Surgery, vol. 65, no. 6, pp. 1673-1679. https://doi.org/10.1016/j.jvs.2016.12.124
Kim GY, Lawrence PF, Moridzadeh RS, Zimmerman K, Munoz A, Luna-Ortiz K et al. New predictors of complications in carotid body tumor resection. Journal of Vascular Surgery. 2017 Jun 1;65(6):1673-1679. https://doi.org/10.1016/j.jvs.2016.12.124
Kim, Gloria Y. ; Lawrence, Peter F. ; Moridzadeh, Rameen S. ; Zimmerman, Kate ; Munoz, Alberto ; Luna-Ortiz, Kuauhyama ; Oderich, Gustavo ; de Francisco, Juan ; Ospina, Jorge ; Huertas, Santiago ; de Souza, Leonardo R. ; Bower, Thomas C. ; Farley, Steven ; Gelabert, Hugh A. ; Kret, Marcus R. ; Harris, E. John ; De Caridi, Giovanni ; Spinelli, Francesco ; Smeds, Matthew R. ; Liapis, Christos D. ; Kakisis, John ; Papapetrou, Anastasios P. ; Debus, Eike S. ; Behrendt, Christian A. ; Kleinspehn, Edgar ; Horton, Joshua D. ; Mussa, Firas F. ; Cheng, Stephen W.K. ; Morasch, Mark D. ; Rasheed, Khurram ; Bennett, Matthew E. ; Bismuth, Jean ; Lumsden, Alan B. ; Abularrage, Christopher J. ; Farber, Alik. / New predictors of complications in carotid body tumor resection. In: Journal of Vascular Surgery. 2017 ; Vol. 65, No. 6. pp. 1673-1679.
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abstract = "Objective This study examined the relationship between two new variables, tumor distance to base of skull (DTBOS) and tumor volume, with complications of carotid body tumor (CBT) resection, including bleeding and cranial nerve injury. Methods Patients who underwent CBT resection between 2004 and 2014 were studied using a standardized, multi-institutional database. Demographic, perioperative, and outcomes data were collected. CBT measurements were determined from computed tomography, magnetic resonance imaging, and ultrasound examination. Results There were 356 CBTs resected in 332 patients (mean age, 51 years; 72{\%} female); 32{\%} were classified as Shamblin I, 43{\%} as Shamblin II, and 23{\%} as Shamblin III. The mean DTBOS was 3.3 cm (standard deviation [SD], 2.1; range, 0-10), and the mean tumor volume was 209.7 cm3 (SD, 266.7; range, 1.1-1642.0 cm3). The mean estimated blood loss (EBL) was 257 mL (SD, 426; range, 0-3500 mL). Twenty-four percent of patients had cranial nerve injuries. The most common cranial nerves injured were the hypoglossal (10{\%}), vagus (11{\%}), and superior laryngeal (5{\%}) nerves. Both Shamblin grade and DTBOS were statistically significantly correlated with EBL of surgery and cranial nerve injuries, whereas tumor volume was statistically significantly correlated with EBL. The logistic model for predicting blood loss and cranial nerve injury with all three variables—Shamblin, DTBOS, and volume (R2 = 0.171, 0.221, respectively)—was superior to a model with Shamblin alone (R2 = 0.043, 0.091, respectively). After adjusting for Shamblin grade and volume, every 1-cm decrease in DTBOS was associated with 1.8 times increase in risk of >250 mL of blood loss (95{\%} confidence interval, 1.25-2.55) and 1.5 times increased risk of cranial nerve injury (95{\%} confidence interval, 1.19-1.92). Conclusions This large study of CBTs demonstrates the value of preoperatively determining tumor dimensions and how far the tumor is located from the base of the skull. DTBOS and tumor volume, when used in combination with the Shamblin grade, better predict bleeding and cranial nerve injury risk. Furthermore, surgical resection before expansion toward the base of the skull reduces complications as every 1-cm decrease in the distance to the skull base results in 1.8 times increase in >250 mL of blood loss and 1.5 times increased risk of cranial nerve injury.",
author = "Kim, {Gloria Y.} and Lawrence, {Peter F.} and Moridzadeh, {Rameen S.} and Kate Zimmerman and Alberto Munoz and Kuauhyama Luna-Ortiz and Gustavo Oderich and {de Francisco}, Juan and Jorge Ospina and Santiago Huertas and {de Souza}, {Leonardo R.} and Bower, {Thomas C.} and Steven Farley and Gelabert, {Hugh A.} and Kret, {Marcus R.} and Harris, {E. John} and {De Caridi}, Giovanni and Francesco Spinelli and Smeds, {Matthew R.} and Liapis, {Christos D.} and John Kakisis and Papapetrou, {Anastasios P.} and Debus, {Eike S.} and Behrendt, {Christian A.} and Edgar Kleinspehn and Horton, {Joshua D.} and Mussa, {Firas F.} and Cheng, {Stephen W.K.} and Morasch, {Mark D.} and Khurram Rasheed and Bennett, {Matthew E.} and Jean Bismuth and Lumsden, {Alan B.} and Abularrage, {Christopher J.} and Alik Farber",
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TY - JOUR

T1 - New predictors of complications in carotid body tumor resection

AU - Kim, Gloria Y.

AU - Lawrence, Peter F.

AU - Moridzadeh, Rameen S.

AU - Zimmerman, Kate

AU - Munoz, Alberto

AU - Luna-Ortiz, Kuauhyama

AU - Oderich, Gustavo

AU - de Francisco, Juan

AU - Ospina, Jorge

AU - Huertas, Santiago

AU - de Souza, Leonardo R.

AU - Bower, Thomas C.

AU - Farley, Steven

AU - Gelabert, Hugh A.

AU - Kret, Marcus R.

AU - Harris, E. John

AU - De Caridi, Giovanni

AU - Spinelli, Francesco

AU - Smeds, Matthew R.

AU - Liapis, Christos D.

AU - Kakisis, John

AU - Papapetrou, Anastasios P.

AU - Debus, Eike S.

AU - Behrendt, Christian A.

AU - Kleinspehn, Edgar

AU - Horton, Joshua D.

AU - Mussa, Firas F.

AU - Cheng, Stephen W.K.

AU - Morasch, Mark D.

AU - Rasheed, Khurram

AU - Bennett, Matthew E.

AU - Bismuth, Jean

AU - Lumsden, Alan B.

AU - Abularrage, Christopher J.

AU - Farber, Alik

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Objective This study examined the relationship between two new variables, tumor distance to base of skull (DTBOS) and tumor volume, with complications of carotid body tumor (CBT) resection, including bleeding and cranial nerve injury. Methods Patients who underwent CBT resection between 2004 and 2014 were studied using a standardized, multi-institutional database. Demographic, perioperative, and outcomes data were collected. CBT measurements were determined from computed tomography, magnetic resonance imaging, and ultrasound examination. Results There were 356 CBTs resected in 332 patients (mean age, 51 years; 72% female); 32% were classified as Shamblin I, 43% as Shamblin II, and 23% as Shamblin III. The mean DTBOS was 3.3 cm (standard deviation [SD], 2.1; range, 0-10), and the mean tumor volume was 209.7 cm3 (SD, 266.7; range, 1.1-1642.0 cm3). The mean estimated blood loss (EBL) was 257 mL (SD, 426; range, 0-3500 mL). Twenty-four percent of patients had cranial nerve injuries. The most common cranial nerves injured were the hypoglossal (10%), vagus (11%), and superior laryngeal (5%) nerves. Both Shamblin grade and DTBOS were statistically significantly correlated with EBL of surgery and cranial nerve injuries, whereas tumor volume was statistically significantly correlated with EBL. The logistic model for predicting blood loss and cranial nerve injury with all three variables—Shamblin, DTBOS, and volume (R2 = 0.171, 0.221, respectively)—was superior to a model with Shamblin alone (R2 = 0.043, 0.091, respectively). After adjusting for Shamblin grade and volume, every 1-cm decrease in DTBOS was associated with 1.8 times increase in risk of >250 mL of blood loss (95% confidence interval, 1.25-2.55) and 1.5 times increased risk of cranial nerve injury (95% confidence interval, 1.19-1.92). Conclusions This large study of CBTs demonstrates the value of preoperatively determining tumor dimensions and how far the tumor is located from the base of the skull. DTBOS and tumor volume, when used in combination with the Shamblin grade, better predict bleeding and cranial nerve injury risk. Furthermore, surgical resection before expansion toward the base of the skull reduces complications as every 1-cm decrease in the distance to the skull base results in 1.8 times increase in >250 mL of blood loss and 1.5 times increased risk of cranial nerve injury.

AB - Objective This study examined the relationship between two new variables, tumor distance to base of skull (DTBOS) and tumor volume, with complications of carotid body tumor (CBT) resection, including bleeding and cranial nerve injury. Methods Patients who underwent CBT resection between 2004 and 2014 were studied using a standardized, multi-institutional database. Demographic, perioperative, and outcomes data were collected. CBT measurements were determined from computed tomography, magnetic resonance imaging, and ultrasound examination. Results There were 356 CBTs resected in 332 patients (mean age, 51 years; 72% female); 32% were classified as Shamblin I, 43% as Shamblin II, and 23% as Shamblin III. The mean DTBOS was 3.3 cm (standard deviation [SD], 2.1; range, 0-10), and the mean tumor volume was 209.7 cm3 (SD, 266.7; range, 1.1-1642.0 cm3). The mean estimated blood loss (EBL) was 257 mL (SD, 426; range, 0-3500 mL). Twenty-four percent of patients had cranial nerve injuries. The most common cranial nerves injured were the hypoglossal (10%), vagus (11%), and superior laryngeal (5%) nerves. Both Shamblin grade and DTBOS were statistically significantly correlated with EBL of surgery and cranial nerve injuries, whereas tumor volume was statistically significantly correlated with EBL. The logistic model for predicting blood loss and cranial nerve injury with all three variables—Shamblin, DTBOS, and volume (R2 = 0.171, 0.221, respectively)—was superior to a model with Shamblin alone (R2 = 0.043, 0.091, respectively). After adjusting for Shamblin grade and volume, every 1-cm decrease in DTBOS was associated with 1.8 times increase in risk of >250 mL of blood loss (95% confidence interval, 1.25-2.55) and 1.5 times increased risk of cranial nerve injury (95% confidence interval, 1.19-1.92). Conclusions This large study of CBTs demonstrates the value of preoperatively determining tumor dimensions and how far the tumor is located from the base of the skull. DTBOS and tumor volume, when used in combination with the Shamblin grade, better predict bleeding and cranial nerve injury risk. Furthermore, surgical resection before expansion toward the base of the skull reduces complications as every 1-cm decrease in the distance to the skull base results in 1.8 times increase in >250 mL of blood loss and 1.5 times increased risk of cranial nerve injury.

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