Carotid artery resection and reconstruction in patients with squamous cell carcinomas of the neck

Abstract

The authors performed a retrospective review of their 10-year experience of carotid artery resection with vascular reconstruction for advanced squamous cell carcinoma of the neck. From 1986 to 1997, four patients underwent elective and one patient acute carotid artery resection with revascularization at the Department of Otolaryngology, Albert Szent-Györgyi Medical University, Szeged, Hungary. Primary lesions were three laryngeal and two hypopharyngeal squamous cell carcinomas. All five resected specimens had metastatic invasion by tumor of the carotid adventitia on pathological examination, while only four specimens exhibited tumorous destruction of the arterial wall. No cerebrovascular accident occurred in any patient, although one patient died postoperatively from cardiac failure. The four remaining patients died of local-regional recurrences or metastatic disease within 17 months after their carotid artery resections. Our findings show that carotid artery resection with replacement is superior to ligation alone in avoiding neurological complications. This approach can provide local control of tumor, but may fail to achieve significant disease-free survival.

Cerebral revascularization and carotid artery resection at the skull base for treatment of advanced head and neck malignancies

“…[13][14][15] Sacrifice of the CA in the neck has been associated with better results than sacrifice of that vessel in the skull base. 3,5,21,28 Malignancies that extensively involve the skull base or that extend into the cavernous sinus, pituitary gland, or orbit are usually contraindications for surgical intervention. 36 Several studies have challenged this view and suggested that there may be an indication to pursue aggressive tumor resection and CA sacrifice with concomitant revascularization.…”

“…When cancers involve the CA in the neck, carotid sacrifice improves the 2-year survival rate but is associated with a significant risk of neurological deficits, stroke, and delayed ischemic complications. 1,3,5,21,28,41 The perioperative mortality rate ranges from 0% to 45%, and the rate of de novo aneurysm formation ranges from 1% to 10%. 1,3,5,21,28,41 Involvement of the ICA at the skull base (cavernous sinus, petrous, or infratemporal segments) has been considered a contraindication for resection.…”

Salvage of advanced squamous cell carcinomas of the head and neck: internal carotid artery sacrifice and extracranial–intracranial revascularization

“…1-3, 6,10,13,28,30,33,36 To reduce the risk of stroke further, some groups have performed a revascularization procedure after the CA is sacrificed. [3][4][5]7,9,11,[17][18][19][20][21]26,27,29,30,32,34,36,37,39,42,45,47,48 Revascularization is usually performed after the tumor is resected. Most procedures have been extracranial, but EC-IC revascularization has been reported.…”

Sacrifice and extracranial reconstruction of the common or internal carotid artery in advanced head and neck carcinoma: Review and meta‐analysis

“…The quality of the methodology of the reports had a median score of 6 (range 4‐10; maximum 10; Table ). The indication for the extracranial reconstruction in 17 studies was head and neck carcinoma involving the common or internal carotid artery . Seven studies included patients with carotid body tumors and patients treated with carotid ligation, carotid‐sparing surgery, or intracranial reconstruction (Table ) .…”

“…In the first case, a neck dissection had been performed 10 days earlier. Salivary leakage with subsequent carotid rupture was managed by resection and reconstruction but the patient died 10 days after this operation . In the other case, a neck dissection had been performed 3 months earlier.…”