IMPROVING OUTCOMES IN CAROTID BODY TUMORS TREATMENT: THE IMPACT OF A MULTIDISCIPLINARY TEAM APPROACH

ABSTRACT Background The purpose of this study was to evaluate how a multidisciplinary approach, including patients and familiar genetic counseling, preoperative succinate-dehydrogenase (SDH) gene mutation analysis, preoperative adjunctive endovascular procedures (PAEPs) and post-operative rehabilitative team may affect the outcomes in patients who underwent surgery for carotid body tumors (CBTs). Methods 57 consecutive CBT resections were performed from January 1995 to December 2019 in a single center institution. Two groups of patients were compared: group A (1995-2003; n=10) and group B (2004-2019; n=47), treated before and after the establishment of a multidisciplinary approach to CBTs. Group A and group B were evaluated retrospectively and prospectively for SDH mutations, respectively. PAEPs (external carotid artery stenting, percutaneous transfemoral embolization or direct percutaneous puncture of the tumor with simultaneous embolization) were performed only in patients of group B, when the size of the tumor exceeded the 45 mm. Primary endpoints were blood loss (BL) and cranial nerve injuries (CNIs). Secondary endpoint was the number of new silent masses (NSMs) discovered after genetic evaluation. Results SDH mutations were found in 2 patients of group A and in 11 patients of group B. There were no significant differences in mass diameter between the groups. A significant difference regarding the surgical procedure time was observed in the two groups, with a higher time in the group A (Group A: 180 ± 77.3; Group B: 138 ± 54.5, p= .04). BL was significantly lower in group B (203 ± 69.5 ml vs 356 ± 102 ml; p= .0001), as well as for patients underwent PAEPs vs those underwent direct surgery (n=15, 149 ± 53 ml vs n=42, 273 ± 88 ml; p= .0001). No differences between transient and persistent CNIs were observed between the two groups. Carotid reconstruction was necessary for two patients of group A (n=2 vs n=0; p=.02). Unilateral tumor recurrence was detected in 7 patients, with a significantly higher rate (p= Conclusions The impact of the multidisciplinary team suggests that surgical resection still remains the gold standard for the treatment of CBTs, but the use of PAEPs in selected cases may reduce surgical procedure time, BL and the need for reconstructive carotid surgery. Genetic counseling and SDH gene analysis allow to diagnose NSMs in asymptomatic patients. Larger studies should be considered to evaluate the effectiveness of post-operative rehabilitative program.