Surgical and non-surgical management of thoracic and cervical paraganglioma - 14/07/23

Doi : 10.1016/j.ando.2022.10.013

Marta Araujo-Castro ^a,^⁎ , Sandra Redondo López ^b, Eider Pascual-Corrales ^a, Rubén Polo López ^c, Teresa Alonso-Gordoa ^d, Javier Molina-Cerrillo ^d, Nicolás Moreno Mata ^e, Usue Caballero Silva ^e, Rafael Barberá Durbán ^c
^a Neuroendocrinology Division, Department of Endocrinology & Nutrition & IRYCIS, Hospital Universitario Ramón y Cajal & Universidad de Alcalá, Madrid, Spain
^b Department of Vascular Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
^c Department of Otorhinolaryngology, Hospital Universitario Ramón y Cajal, Madrid, Spain
^d Department of Medical Oncology, Hospital Universitario Ramón y Cajal & IRYCIS, Madrid, Spain
^e Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain

^⁎Corresponding author. Colmenar Viejo street, 28034 Madrid, Spain.Colmenar Viejo streetMadrid28034Spain

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Resumen

Key points

•	Surgery is generally considered the treatment of choice for thoracic and cervical paraganglioma (PGL).
•	For thoracic PGL, video-assisted thoracoscopic surgery (VATS) is the main surgical approach.
•	For cervical PGL, the surgical approach should be individualized based on the Glasscock-Jackson and the Fisch-Mattox classifications.
•	Radiotherapy may be a more suitable option in unresectable cervical and thoracic PGL or when resection has been partial.

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Abstract

Thoracic and cervical paragangliomas (PGLs) are rare neuroendocrine tumors arising from chromaffin cells of the neural crest progenitors located outside the adrenal gland. We describe our current protocol as a multidisciplinary team for the management of cervical and thoracic PGLs. Surgery is generally considered the treatment of choice as it offers the best chance for cure. For resection of thoracic PGLs, video-assisted thoracoscopic surgery (VATS) is the main surgical approach, while open thoracotomy is preferred in case of tumors > 6cm, lacking confirmation of a plane of separation with adjacent structures, or with technical difficulties during VATS. In cervical PGLs, the surgical approach should be individualized according to location, mainly based on the Glasscock-Jackson and the Fisch-Mattox classifications. Surgery is the treatment of choice for most cervical and thoracic PGLs, but radiotherapy or observation could be more suitable options in unresectable cervical and thoracic PGLs or when resection has been incomplete.

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Keywords : Thoracic paraganglioma, Cervical paraganglioma, Tympanic paraganglioma, Video-assisted thoracoscopic surgery, Vagal paraganglioma