Management of Carotid Artery Invasion in Advanced Malignancies of Head and Neck Comparison of Techniques

Abstract

The objective of this study was to retrospectively investigate a single institution's experience with carotid artery resection performed as part of an oncological procedure and to determine acute and convalescent complication and survival rates. We performed a record review of 28 patients with head and neck malignancy invading the carotid artery. Immediate carotid artery resection and ligation on an emergent basis was performed on 12 patients (group 1), elective resection and ligation was performed on 8 patients (group 2), and elective resection and revascularization was performed on 8 patients (group 3). In group 1, although 1 patient survived for 1 year and 1 patient survived for 2 years, 1 patient died of severe neurologic deficit, 2 patients experienced neurologic deficit with good recovery, and 1 patient was moderately disabled. In group 2, 2 patients survived without disease for 5 years, and 2 patients experienced neurologic deficit, 1 with good recovery and the other with complete recovery. In group 3, only 1 patient survived for 5 years, and within this group, 1 patient died of severe neurologic deficit, 1 patient had neurologic deficit with moderate recovery, and 1 patient had neurologic deficit with complete recovery. No significant difference in mortality and morbidity rate was observed between the "resection and ligation" group and the "resection and revascularization" group (p = .52, chi(2) = 0.79). We conclude that the surgical treatment of patients with an invaded carotid artery, including carotid resection, provides a small but real chance of 5-year survival. The methods of carotid resection and repair should be guided by clinical presentation and by preoperative and intraoperative investigations.

Survival and complications after carotid resection for head and neck squamous cell carcinoma: A systematic review and pooled analysis

“…After applying the abovementioned inclusion and exclusion criteria, 23 articles were finally included. 5, The reasons behind the exclusions of 129 studies are shown in Figure 1.…”

“…3 However, certain authors argue that the neurovascular complications and functional consequences resulting from such extensive neck dissection should discourage surgical intervention. 4,5 On the other hand, radiotherapy alone or in combination with concurrent chemotherapy is an alternative, though it does subject patients to immediate or delayed adverse effects, and its effectiveness might be diminished with large tumor volumes. [6][7][8][9] This scenario is most frequently encountered in patients who undergo a secondary resection following the failure of prior surgical or chemoradiation treatments.…”

“…In cases where the tumor encircles or infiltrates the carotid artery, carotid resection may be required to achieve complete tumor removal 3 . However, certain authors argue that the neurovascular complications and functional consequences resulting from such extensive neck dissection should discourage surgical intervention 4,5 . On the other hand, radiotherapy alone or in combination with concurrent chemotherapy is an alternative, though it does subject patients to immediate or delayed adverse effects, and its effectiveness might be diminished with large tumor volumes 6–9 .…”

When Everything Revolves Around Internal Carotid Artery: Analysis of Different Management Strategies in Patients With Very Advanced Cancer Involving the Skull Base

“…In fact, several series of HNCs, mostly represented by squamous cell carcinoma (SCC), treated through CA resection-including surgery reported a 2-year overall survival rate as low as 11.1-50.0% (13)(14)(15)(16). On the other hand, perioperative mortality (10-25%) (17)(18)(19) and risk for cerebrovascular (12.5-33%) (13-16) and non-cerebrovascular complications (25-60%) (13,14,16,20) are non-negligible in patients receiving CA resection-including surgery. Despite cerebral revascularization is supposed to reduce the incidence of cerebrovascular events (19,21), the comparative study by Aslan et al was unable to demonstrate a significant difference (17).…”

“…On the other hand, perioperative mortality (10-25%) (17)(18)(19) and risk for cerebrovascular (12.5-33%) (13-16) and non-cerebrovascular complications (25-60%) (13,14,16,20) are non-negligible in patients receiving CA resection-including surgery. Despite cerebral revascularization is supposed to reduce the incidence of cerebrovascular events (19,21), the comparative study by Aslan et al was unable to demonstrate a significant difference (17). Cerebral revascularization can be achieved through either CA reconstruction, which is technically feasible when common CA and/or extracranial (i.e., parapharyngeal) internal CA are resected, or bypass surgery, which consists of creating a communication between a donor arterial system, such as the external carotid one, and the cerebral vascularization (e.g., to the middle cerebral artery) via an interpositional vascular graft.…”