Carotid reconstruction in patients operated for malignant head and neck neoplasia
Keywords:
Head and neck neoplasms, Carotid arteries, Neck neoplasms, Neoplasia, Carotid artery diseases, Carotid, Artery, Vascular, Resection, Arterial, GraftingAbstract
CONTEXT: Patients with malignant head and neck neoplasia may present simultaneous involvement of large vessels due to the growth of the tumoral mass. The therapeutic options are chemotherapy, radiotherapy, surgery or combined treatments. OBJECTIVE: To analyze the result of surgical treatment with carotid reconstruction in patients with advanced malignant head and neck neoplasia. DESIGN: Prospective. SETTING: Hospital do Câncer A.C. Camargo, São Paulo, Brazil. PARTICIPANTS: Eleven patients operated because of advanced malignant head and neck neoplasia that was involving the internal and/or common carotid artery. MAIN MEASUREMENTS: By means of clinical examination, outpatient follow-up and duplex scanning, we analyzed the patency of the carotid grafts, vascular and non-vascular complications, disease recurrence and survival of the patients. RESULTS: Six patients (54.5%) did not present any type of complication. There was one vascular complication represented by an occlusion of the carotid graft with a cerebrovascular stroke in one hemisphere. Non-vascular complications occurred in five patients (45.5%). During the follow-up, eight patients died (72.7%), of whom seven had locoregional tumor recurrence and one had pulmonary and hepatic metastases (at an average of 9 months after the operation). Seven of these patients presented functioning grafts. The three patients still alive have no tumor recurrence and their grafts are functioning (an average of 9 months has passed since the operation). CONCLUSIONS: Patients with advanced malignant head and neck neoplasia involving the carotid artery that are treated surgically present a prognosis with reservations. When the internal and/ or common carotid artery is resected en-bloc with the tumor, arterial reconstruction must be performed. The long saphenous vein is a suitable vascular substitute.
Downloads
References
Shah JP, Cendron RA, Farr HW, Strong EW. Carcinoma of the oral cavity: factors affecting treatment failure at the primary site and neck. Am J Surg 1976;132:504-7.
Dulguerov P, Soulier C, Maurice J, et al. Bilateral radical neck dissection with unilateral internal jugular vein reconstruction. Laryngoscope 1998;108:1692-6.
Ahn C, Sindelar WF. Bilateral radical neck dissection: report of results in 55 patients. J Surg Oncol 1989;40:252-5.
Brennan JA, Jafek BW. Elective carotid artery resection for ad- vanced squamous cell carcinoma of the neck. Laryngoscope 1994;104:259-63.
Moore O, Baker HW. Carotid artery ligation in surgery of the head and neck.. Cancer 1955;8:712-26.
Konno A, Togawa K, Iizuka K. Analysis of factors affecting com- plications of carotid ligation. Ann Otol Rhinol Laryngol 1981;90:222-6.
McCready RA, Miller SK, Hamaker RC, Singer MI, Herod GT. What is the role of carotid arterial resection in the manage- ment of advanced cervical cancer? J Vasc Surg 1989;10:274-80.
Loré JM, Boulos EJ. Resection and reconstruction of the ca- rotid artery in metastatic squamous cell carcinoma. Am J Surg 1981;142:437-42.
Snyderman CH, D’Amico F. Outcome of carotid artery resec- tion for neoplastic disease: a meta-analysis. Am J Otolaryngol 1992;13:373-80.
Reilly MK, Perry MO, Neterville JL, Meacham PW. Carotid artery replacement in conjunction with resection of squamous cell carci- noma of the neck: preliminary results. J Vasc Surg 1992;15:324-9.
Wright JG, Nicholson R, Schüller DE, Smead WL. Resection of the internal carotid artery and replacement with greater saphenous vein: a safe procedure for en-bloc cancer resection with carotid involvement. J Vasc Surg 1996;23:775-80.
Ketchum AS, Haye RC. Spontaneous carotid artery hemorrhage after head and neck surgery. Am J Surg 1965;110:649-55.
Kennedy JT, Krause CJ, Loevy S. The importance of tumor attach- ment to the carotid artery. Arch Otolaryngol 1977;103:70-3.
Karam F, Shaefer S, Cherryholmes D, Dagher FJ. Carotid ar- tery resection and replacement in patients with head and neck malignant tumors. J Cardiovas Surg 1990;31:697-701.
Maves MD, Bruns MD, Keenan MJ. Carotid artery resection for head and neck cancer. Ann Otol Rhinol Laryngol 1992;101:778-81.
Bole PV, Hintz G, Chandler P, et al. Bilateral carotid aneu- rysms secondary to radiation therapy. Ann Surg 1975;181:888- 91.
De Vries EJ, Sekhar LN, Horton JA, et al. A new method to predict safe resection of the internal carotid artery. Laryngo- scope 1990;100:85-8.
Martinez SA, Oller DW, Gee W, De Fries HO. Elective carotid artery resection. Arch Otolaryngol 1975;101:744-7.
Ehrenfeld WK, Stoney RJ, Wylie EJ. Relation of carotid stump pres- sure to safety of carotid artery ligation. Surgery 1983;93:299-305.
Atkinson DP, Jacobs LA, Weaver AW. Elective carotid resection for squamous cell carcinoma of the head and neck. Am J Surg 1984;148:483-8.
Sessa CN, Morasch MD, Berguer R, et al. Carotid resection and replacement with autogenous arterial graft during opera- tion for neck malignancy. Ann Vasc Surg 1998;12:229-35.
Jacobs JR, Arden RL, Marks SC, Kline R, Berguer R. Carotid artery reconstruction using superficial femoral arterial grafts. Laryngoscope 1994;104:689-93.
Rella AJ, Rongetti JR, Bisi R. Replacement of carotid arteries with prosthetic graft. Arch Otolaryngol 1962;76:76-80.
Blume WT, Ferguson GG, McNeill DK. Significance of EEG changes in carotid endarterectomy. Stroke 1986;17:891-7.
Jansen C, Vrien EM, Eikelboom BC, et al. Carotid endar- terectomy with transcranial Doppler and electroencepha- lographic monitoring. Stroke 1993;24:665-9.
Benjamin ME, Silva MB, Watt C, et al. Awake patient moni- toring to determine the need for shunting during carotid en- darterectomy. Surgery 1993;114:673-81.
Gumerlock MK, Neuwelt EA. Carotid endarterectomy: to shunt or not to shunt. Stroke 1988;19:1485-90.
Frawley JE, Hicks RG, Gray LJ, Niesche JW. Carotid endarterec- tomy without a shunt for symptomatic lesions associated with con- tralateral severe stenosis or occlusion. J Vasc Surg 1996;23:421-7.
Ehrenfeld WK, Hamilton FN, Larson CP Jr, Hickey RF, Severinghaus JW. Effect of CO2 and systemic hypertension on downstream cerebral arterial pressure during carotid endarter-ectomy. Surgery 1970;67(1):87-96.
Katsuno S, Ishiyama T, Sakaguchi M, Takemae H. Carotid re- section and reconstruction for advanced cervical cancer. Laryn- goscope 1997;107:661-4.
Salles LRA, Puech-Leão P, Netto BM, et al. Risk factors of stroke in carotid endarterectomy. Rev Hosp Clín Fac Med S Paulo 1997;52(6):291-4.
Ott DA, Cooley DA, Coelho A. Carotid endarterectomy with- out temporary intraluminal shunt. Ann Surg 1980;191:708-14.
Byers RM. Factors affecting choice of initial therapy in oral cancer. Semin Surg Oncol 1995;11:183-9.
