Literature ReviewRole of Preoperative Embolization in Carotid Body Tumor Surgery: A Systematic Review and Meta-Analysis
Introduction
Paragangliomas are a subset of neuroendocrine tumors in the extra-adrenal paraganglia that arise from the embryonic neural crest cells.1, 2 Carotid paragangliomas, commonly referred as carotid body tumors (CBTs), are the most common neuroendocrine tumors in the head and neck.3 They are most commonly located at the bifurcation of the common carotid artery and usually present as a painless neck mass; however, larger CBTs can present with cranial nerve (CN) palsies.4 Most CBTs are benign in nature and present during the third or fourth decade of life.2
Carotid paragangliomas are highly vascularized tumors which can make tumor resection particularly challenging.5 Specifically, vascular and neurologic sequelae are feared complications of CBT surgical therapy.6 Schick et al.7 first introduced the concept of preoperative embolization in 1980 and reported the first such CBT resection. Since then, several studies have evaluated the impact of preoperative embolization on CBT surgery.5, 8, 9 There is evidence suggesting that preoperative selective embolization may reduce blood loss during surgery and decrease the risk of perioperative complications10; however, recent reports have cast doubt and questioned the benefits preoperative embolization may provide.11
The aim of this systematic review and meta-analysis was to synthesize all comparative studies that investigated the impact of preoperative embolization on CBT surgical resection and identify whether there is a temporal component of embolization that can affect postoperative outcomes.
Section snippets
Methods
This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.12
Search Results
The literature search yielded 406 potentially relevant records after duplicates were removed. After screening titles and abstracts, 52 articles were retrieved for full-text evaluation. Twenty-five studies met the predetermined eligibility criteria and were included in the meta-analysis as shown in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram (Figure 1).
Characteristics of the Included Studies
All 25 studies were retrospective observational cohort analyses and comprised a total of 1326 patients
Discussion
This meta-analysis showed that patients who received embolization prior to CBT resection had statistically significant lower blood loss and shorter duration of operation. The rates of CN palsy, stroke, TIA, and length of stay were similar between patients who had preoperative embolization and those who did not.
It has been already shown that complications of carotid body paraganglioma resection are associated with increased tumor size.38 These tumors, although mostly benign, usually require
Conclusions
The present meta-analysis showed that embolization prior to CBT resection is associated with statistically significant lower blood loss and shorter duration of operation compared with patients who did not have preoperative embolization. However, it is unknown whether these differences are clinically significant. CN palsy, stroke, TIA, and length of stay were similar between the 2 groups. Future studies should provide outcomes based on tumor size and Shamblin classification and investigate the
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Pavlos Texakalidis and Nektarios Charisis are co–first authors.