Is Carotid Reconstruction for Advanced Cancer in the Neck a Safe Procedure?

Abstract

Head and neck surgeons hesitate to resect the carotid artery because of the postoperative risk of neurologic sequelae. On the other hand, there is no curative therapeutic option for head and neck cancer involving the carotid artery, except for complete tumor removal. A retrospective review of all published articles in the English literature dealing with carotid reconstruction for head and neck cancer from 1987 to 1998 was performed. There were only 11 articles, including our series, that reported outcomes of this procedure. Among the 148 patients of this series, major neuromorbidity was 4.7%, and mortality occurred in 6.8% of the patients. Combined major neuromorbidity and mortality was 10.1%. Because total removal of the advanced cancer is the only therapy that can offer the patients a chance for cure, head and neck surgeons should aggressively perform carotid resection and reconstruction.

Carotid Resection and Reconstruction Associated with Treatment of Head and Neck Cancer

“…Other studies have reported 1-year disease-free survival to be as high as 44% (7-9). Katsuno reported 40% to be free of disease at 2 years (10). Th e rate of distant metastases also decreased in the absence of recurrence in the neck (1).…”

Carotid Artery Resection and Reconstruction With Expanded Polytetrafluoroethylene for Head and Neck Cancer

“…En bloc resection of the tumor together with invaded segment of carotid artery followed by vascular reconstruction became an option in management of locally advanced head and neck cancer. Katsuno 7 reviewed 148 patients with carotid reconstruction after resection. The major neurological morbidity and mortality rates were 4.7% and 6.8%, respectively.…”

Status of Carotid Resection in Head and Neck Cancer

“…Survival rates during relatively short follow-up periods of 1 -2 years have ranged from 44% to 0% (8,12). Some authors do not report overall oncologic results, but a report mentioned that 4:10 patients were free of disease for \ 2 years (16). Other authors report similar results but the number of patients in each series is small and the average followup period is too short in most cases.…”

“…The currently reported functional and oncologic results of carotid resection with graft reconstruction could be described as acceptable. Katsuno et al (16) recently reviewed 148 patients in whom carotid resection and immediate grafting were performed. Operative mortality was 6.8% and major neuromorbidity occurred in 4.7% of the patients.…”