Treatment of recurrent head and neck carcinoma involving the carotid artery: carotid reconstruction with ePTFE graft

Abstract

The aim of our study is to investigate the feasibility of reconstructing the carotid artery using expanded polytetraflouroethylene (ePTFE) in patients with recurrent head and neck carcinoma involving the carotid artery. Ten patients, who had recurrent head and neck carcinoma involving the carotid artery, received carotid artery resection and reconstruction with ePTFE, tissue defects were repaired by pectoralis major myocutaneous flap. Results show that eight patients did not present any vascular and neurologic complications. One patient presented slight hemiparesis, another patient developed wound infection and pharyngocutaneous fistula. The mean follow-up period was 33.1 ± 16.0 months. The 2-year survival rate was 50% (5/10), and there was one patient who survived for 60 months without locoreginal recurrence or distant metastasis. En bloc resection of tumor and involved carotid-associated ePTFE reconstruction provide effective improvement in the locoregional control of the recurrent head and neck carcinoma. The pedicle pectoralis major myocutaneous flap can provide not only wound bed with affluent blood supply for the vascular grafts, but also reparation of skin or the tissue defects of oropharynx and hypopharynx.

Clinical outcome analysis of 47 patients with advanced head and neck cancer with preoperative suspicion of carotid artery invasion

“…15 Specifically, it has been reported that 5% to 20% of patients do not present any neurologic deficits during the temporary balloon occlusion test but will experience stroke after permanent carotid artery occlusion. 16 In our series, major neurologic sequelae developed in 3 patients (6.4%). However, there was no patient who had major neurologic sequelae immediately after surgery.…”

“…However, whereas clinical tolerance to carotid artery BOT reduces the morbidity and mortality associated with permanent arterial occlusion, they are, unfortunately, not eliminated . Specifically, it has been reported that 5% to 20% of patients do not present any neurologic deficits during the temporary balloon occlusion test but will experience stroke after permanent carotid artery occlusion …”

“…If reconstructed vessels rupture as a result of local infection, higher neuromorbidity and mortality rates are inevitable. To prevent postoperative infection, covering the surgical dead space with a myocutaneous flap or creating a prophylactic pharyngostoma is necessary . In this study, the vascular grafts were encompassed by the muscle surface of the vascularized pedicled muscle flap, which provided competent blood supply.…”

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 ) .…”

“…The follow‐up time of the reports varied from 18 days to 175 months; this time was not reported in 2 articles. In 5 articles, the mean follow‐up time was more than 2 years …”