Pros and cons of surgical versus conservative management for head and neck paraganglioma: a real-world data analysis

Purpose: To compare functional deficits associated to surgery with those caused by the growth of the head and neck paragangliomas (HNPGLs). Methods: 72 patients with HNPGLs were included. Patients were divided in group A (49 patients undergoing surgery) and group B (23 patients following a wait and see approach). Each patient was subjected to clinical evaluation and genetic testing. The presence of functional neurological deficits in speech or swallowing and quality of life were assessed via a dedicated otolaryngologist visit, three posted questionnaires (VHI, DHI, and MDADI), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35. Results: Thirty-four patients from group A (69.4%) and 18 from group B (78.2%) agreed to fill out the posted questionnaires. Eighteen patients from group A (36.7%) and 10 from group B (43.5%) underwent a dedicated otolaryngologist visit. A significant difference between group A and B was observed in the VHI (p = 0.001) and DHI scoring (p = 0.020), and at the otolaryngologist visit (mild neurological disabilities, p = 0.007). Patients with familial forms presented multiple HNPGLs (p = 0.011), multiple secreting lesions (p = 0.010) and underwent surgery more times for HNPGLs (p = 0.009) and for both HNPGLs and sympathetic PGLs (p = 0.015). ROC curve analysis suggests that surgery in carotid body tumors >34 mm may be more frequently associated with nerve injury. Conclusion: The management of HNPGL patients remains challenging for clinicians. This preliminary study seems to suggest that surgery still represents the first choice for patients with small lesions. An accurate clinical evaluation is mandatory to avoid non-resolving surgery and possible neurovascular long-term complications.