Carotid reconstruction in patients operated for malignant head and neck neoplasia

Abstract

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 loco-regional 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.

Significado prognóstico do linfonodo metastático N3 em carcinomas epidermóides de cabeça e pescoço

“…Por muito tempo as metástases que invadiam a carótida foram consideradas irressecáveis. Todavia, o critério de ressecabilidade destas lesões tem se alterado nos últimos anos, em conseqüência da evolução técnica, mas continua a provocar controvérsias devido à significativa morbi-mortalidade e aos baixos índices de sobrevida 10,11 . A ressecção da subadventícia é considerada paliativa, pois freqüentemente é incompleta, e também coloca o vaso em risco de ruptura, seja pelo adelgaçamento da parede, crescimento do tumor residual ou efeito da radioterapia.…”

Functional properties of fresh and cryopreserved carotid and femoral arteries, and of venous and synthetic grafts: comparison with arteries from normotensive and hypertensive patients

“…recurrent stenosis with inability to perform endarterectomy, arterial aneurysm, advanced cancer of the neck with involvement of the CA) (Sise et al 1992;Snyderman and D'Amico 1992;Law et al 1995;Wright et al 1996;Sessa et al 1998;Nishinari et al 2002). The re-establishment of the carotid flow can be performed via the interposition of a by-pass between the vessel stumps, by utilizing a synthetic substitute, like expanded polytetrafluoroethylene (ePTFE) or an autologous vein (Sise et al 1992;Snyderman and D'Amico 1992;Law et al 1995;Wright et al 1996;Sessa et al 1998;Nishinari et al 2002).…”

“…Synthetic prostheses are well tolerated but heal very little, the wall may incorporate bacterial colonies, and additionally, patients appear to be at high risk for a second stenosis (Sise et al 1992;Sessa et al 1998). Since the autologous substitutes have a greater biological compatibility, and a lesser risk of infection, some clinicians prefer their use in arterial reconstruction, and the autologous saphenous vein (SV) is among the most utilized (Wright et al 1996;Nishinari et al 2002). However, SV is not always available, due to disease or previous use (Sessa et al 1998).…”

“…However, SV is not always available, due to disease or previous use (Sessa et al 1998). The mechanical strength, and durable resistance to infection and thrombosis, makes the superficial femoral artery (FA) a viable alternative conduit for CA bypass or reconstruction (Wright et al 1996;Sessa et al 1998;Nishinari et al 2002;Fields and Bower 2004). However, the use of autologous FA has limitations, due to at least two important reasons.…”

Arterial Reconstructions Associated With the Resection of Malignant Tumors.

“…Most studies reporting on patients undergoing peripheral arterial reconstructions associated with resection of malignant neoplasia only deal with 1 body segment, such as the neck, 10,11 lower extremities, 12,13 abdomen, 9,14 or upper extremities. 15 The largest sample in any of these studies is 32 patients.…”