Purpose: Carotid body tumors though not common are considered one of the toughest cases to be managed surgically especially due to their high vascularity and proximity to vital structures . Delayed presentation with large tumors with complications like nerve palsies are not uncommon. We studied the clinical profile, interventions, and outcomes of these tumors and assessed the various factors influencing operative morbidity and recurrence. Methodology: This retrospective study was conducted at the Christian Medical College in Vellore, a tertiary care center in south India. We analyzed the patients from Feb 1st, 2009 to June 30th, 2024. Results: 176 of 182 tumors were excised from 171 patients (91 female, 80 male). Average age at presentation was 36.4 years, and 8 patients had familial bilateral tumors. Most common presentation was a painless neck mass. There were 84 Shamblin group III, 85 Shamblin group II, and 7 Shamblin group I tumors. 47 Shamblin group II/III tumors were associated with transient cranial nerve palsy or paresis (26.7%). 9 patients underwent ICA interposition repair either with reversed saphenous vein or PTFE.8 Shamblin group III tumors were associated with perioperative stroke (4.5%). Preoperative embolization was done in 22 tumors with 5 patients having serious complications. 8 patients had persistent nerve palsy . 17 patients required mandibular subluxation and 7 mandibular swing.3 patients required craniotomy to excise the residual tumor.Average blood loss ranged from 350ml to 2.5l.2 patients had recurrence Conclusions: Carotid body tumors are still one of the challenging cases for a vascular surgeon.They require multi modal approach involving proper evaluation ,preoperative embolization,additional exposure methods like mandibular swing and appropriate post operative management.