Carotid chemodectomas: questions to ensuring radicality, efficacy, and safety of surgical treatment.

BACKGROUND: In Russia and the world, there is an increase in the number of cancer patients with localization on the head and neck. According to the Global Cancer Observatory (GLOBOCAN), 890.000 new cases of head and neck cancer and 450.000 deaths were registered in 2018, with a forecast of a 30% increase in the incidence by 2030. Carotid chemodectomas (CC) account for 0.5% of all head and neck tumors. The frequency of occurrence is estimated as 1 per 30000-100000 people. CCS in most patients are benign, but 10% may be malignant. The aim to determine the rational surgical tactics in patients with carotid hemodectomas, from the standpoint of the radicality, effectiveness and safety of the operation. STUDY DESIGN: a retrospective, multicenter study. MATERIAL AND METHODS: An analysis was conducted of the medical records of 80 patients with CBTs who underwent treatment in the vascular surgery departments of Regional Clinical Hospital No. 3, City Clinical Hospital No. 8, Chelyabinsk Regional Clinical Hospital and Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine in Chelyabinsk from 1985 to 2025. In particular, the results of instrumental research methods were assessed and a histological analysis of the obtained biopsy materials was performed. The literature search, as well as the systematization and analysis of information, was conducted from scientific literature sources located in the PubMed, Web of Science, and Elibrary databases. RESULTS: When writing the work, a literature search was conducted, as well as an analysis of the most significant clinical observations of patients with CС, including those with signs of malignancy, bilateral lesion, hereditary history, as well as a combination of tumors with atherosclerotic lesions of the internal carotid artery and the development of critical stenosis. CONCLUSION: To ensure the radicality, efficacy, and safety of carotid body tumor removal, the following principles should be considered: for type III tumors according to the Shamblin classification, as well as for tumors with malignant properties, en bloc resection followed by internal carotid artery reconstruction is advisable. The sequence of tumor removal in bilateral cases is determined by their size, Shamblin classification, and the presence of symptoms. Simultaneous bilateral tumor removal should not be performed due to the risk of fatal complications. Lymph node dissection should be performed in cases of enlarged lymph nodes in the surgical area, tumor recurrence, and aggressive or malignant tumor forms. Preoperative embolization of branches of the external carotid artery prior to surgical tumor removal has not proven its effectiveness. Patients with carotid body tumors, especially those with a family history or multiple tumors, are recommended to undergo genetic testing.