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Yadav K. Radical Neck Dissection Following Internal Carotid Artery Endovascular Stenting: Case Report and Review of Literature. Indian J Surg Oncol 2024; 15:397-404. [PMID: 38741633 PMCID: PMC11088597 DOI: 10.1007/s13193-024-01912-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/27/2024] [Indexed: 05/16/2024] Open
Abstract
Carotid artery involvement by head and neck cancer is mostly considered as unresectable disease. Mostly, these cases are treated with definitive chemoradiotherapy. But when there is recurrent disease, choices are limited. Recent advances in vascular reconstruction and intervention radiology lead the way of addressing these cases with reconstruction or endovascular stenting. We tried to address this challenge in the present case. Endovascular stent provided the protection needed while dissecting over internal carotid artery. Such uncommonly performed techniques should be highlighted for further research.
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Vikatmaa P, Pilz M. Expanding Treatment Options in Hopeless Situations: The Value of Endovascular Therapy in Carotid Blowout Syndrome. Eur J Vasc Endovasc Surg 2024; 67:717. [PMID: 38295941 DOI: 10.1016/j.ejvs.2024.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Pirkka Vikatmaa
- Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Manuela Pilz
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
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Vikatmaa P. Emergencies during oncovascular surgery: Strategies and pitfalls. Semin Vasc Surg 2023; 36:157-162. [PMID: 37330230 DOI: 10.1053/j.semvascsurg.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 06/19/2023]
Abstract
In a growing number of pathologies, vascular invasion is no longer considered a contraindication for surgery with a curative intention. This has led vascular surgeons to be more involved in the treatment of pathologies that they are not used to. These patients should be managed in a multidisciplinary manner. New types of emergencies and complications have emerged. Emergencies in oncovascular surgery are mostly avoidable with careful planning and good collaboration between oncological surgeons and a dedicated vascular surgery team. The operations often involve difficult vascular dissection and complex reconstructive techniques in a potentially contaminated and irradiated field, and the risk of postoperative complications and blow out is increased. However, after a successful operation and immediate postoperative course, the patients often recover faster than the typical fragile vascular surgical patient. This narrative review focuses on emergencies that are more or less specific to oncovascular procedures. A scientific approach and international collaboration are needed, so that we can better identify which patients should be operated, what problems to anticipate and could be avoided with better planning, and which solutions improve patient outcome.
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Affiliation(s)
- Pirkka Vikatmaa
- Vascular Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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Zhao Y, Bao D, Wang X, Lin M, Li L, Zhu Z, Zhao X, Luo D. Prediction model based on preoperative CT findings for carotid artery invasion in patients with head and neck masses. Front Oncol 2022; 12:987031. [PMID: 36276062 PMCID: PMC9582344 DOI: 10.3389/fonc.2022.987031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesTo investigate the performance of a model in predicting carotid artery (CA) invasion in patients with head and neck masses using computed tomography (CT).MethodsThis retrospective study included patients with head and neck masses who underwent CT and surgery between January 2013 and July 2021. Patient characteristics and ten CT features were assessed by two radiologists. The patients were randomly allocated to a training cohort (n=106) and a validation cohort (n=109). Independent risk factors for CA invasion were assessed by univariate and multivariate logistic regression analyses. The predictive model was established as a nomogram using the training cohort. In addition, the calibration, discrimination, reclassification, and clinical application of the model were assessed in the validation cohort.ResultsA total of 215 patients were evaluated, including 54 patients with CA invasion. Vascular wall deformation (odds ratio [OR], 7.17; p=0.02) and the extent of encasement to the CA (OR, 1.02; p<0.001) were independent predictors of CA invasion in the multivariable analysis in the training cohort. The performance of the model was similar between the training and validation cohort, with an area under the receiver operating characteristic curve of 0.93 (95% confidence intervals [CI], 0.88-0.98) and 0.88 (95% CI, 0.80-0.96) (p=0.07), respectively. The calibration curve showed a good agreement between the predicted and actual probabilities.ConclusionA predictive model for carotid artery invasion can be defined based on features that come from patient characteristics and CT data to help in improve surgical planning and invasion evaluation.
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Affiliation(s)
- Yanfeng Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dan Bao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyi Wang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Lin
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Li
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Zhu
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinming Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dehong Luo
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
- *Correspondence: Dehong Luo,
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Abolfotouh S, Bäck L, Aro K, Lassus P, Vuola J, Mesimäki K, Wilkman T, Vikatmaa P. Carotid interposition in patients with head and neck tumors: clinical experience of 13 cases reconstructed with a great saphenous vein autograft. Acta Otolaryngol 2022; 142:419-424. [PMID: 35499961 DOI: 10.1080/00016489.2022.2067356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Carotid interposition graft (CIG) surgery in the setting of head & neck cancer (HNC) is a rare procedure with a limited number of cases described in the literature. AIMS/OBJECTIVES To assess the outcomes of the surgery at Helsinki University Hospital. MATERIALS AND METHODS Patients who underwent CIG in a head and neck tumor surgery were retrospectively analyzed over 15 years. Overall-survival (OS) was calculated until 1 May 2020. The primary-outcome was to measure the 30-day OS, postoperative stroke rate, and other complications. The secondary-outcome was to measure 1-, 2-, and 5-year OS. RESULTS Thirteen patients were identified, 11 with HNC and two with Shamblin III Carotid Body Tumors. The great saphenous vein was used for all vascular reconstructions, and shunting was routinely performed. The 30-day stroke incidence was nil. Two graft-blowouts were encountered, one of which lead to death and the other was successfully managed. For HNC patients, the locoregional recurrence-rate was 36%. The 5-year OS was 46.2%. CONCLUSION AND SIGNIFICANCE CIG in HNC setting can achieve oncologic-control with an acceptable rate of complications. Routine shunting, heparinization, and elevating blood-pressure during closure seem to be safe protocols to maintain cerebral-circulation perioperatively. A moderate graft-blowout risk should be considered.
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Affiliation(s)
- Sherif Abolfotouh
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leif Bäck
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katri Aro
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Patrik Lassus
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jyrki Vuola
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karri Mesimäki
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tommy Wilkman
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirkka Vikatmaa
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Mikoshiba T, Sakamoto K, Shinden S, Shimanuki M, Nakayama R, Okada T, Ozawa H. Utility of computed tomography findings as a predictor of carotid artery invasion by metastatic lymph nodes in head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 2022; 279:4561-4568. [PMID: 35486174 DOI: 10.1007/s00405-022-07393-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/05/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Carotid artery invasion by metastatic lymph nodes in head and neck squamous cell carcinoma (HNSCC) is one of the diagnostic criteria for unresectable tumors. However, to date, the diagnostic criteria for carotid artery invasion have not been well documented. This study investigated the utility of computed tomography (CT) findings as a predictor of carotid artery invasion by metastatic lymph nodes in HNSCC. METHODS Twenty-eight patients who had metastatic lymph nodes of HNSCC attached to the carotid artery as seen on CT images before neck dissection from January 2011 to November 2017 were included. Five imaging parameters (angle of contact [AC], length of contact [LC], haziness of the carotid artery wall [HW], size of the lymph node, and involvement of the bifurcation of the carotid artery [IB]) were assessed using CT to predict carotid artery invasion. Furthermore, the utility of the combination of these five parameters was evaluated. RESULTS There were significant differences in AC, LC, and IB between patients with and without carotid artery invasion. There were significant differences in all combinations of the two image findings between patients with and without carotid artery invasion. In particular, the combinations of LC and HW, and LC and IB could clearly predict carotid artery invasion. CONCLUSION AC, LC, and IB were useful predictors of carotid artery invasion of metastatic lymph nodes in HNSCC. This study is the first to report that IB is a useful predictor of carotid artery invasion in HNSCC.
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Affiliation(s)
- Takuya Mikoshiba
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.,Department of Otorhinolaryngology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, Japan
| | - Koji Sakamoto
- Department of Otorhinolaryngology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, Japan.
| | - Seiichi Shinden
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.,Department of Otorhinolaryngology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, Japan
| | - Marie Shimanuki
- Department of Otorhinolaryngology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, Japan
| | - Rie Nakayama
- Department of Otorhinolaryngology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, Japan
| | - Takashi Okada
- Department of Otorhinolaryngology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, Japan
| | - Hiroyuki Ozawa
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
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Resection and reconstruction of the carotid artery for head and neck squamous cell carcinoma: a GETTEC study. Eur Arch Otorhinolaryngol 2022; 279:4515-4523. [PMID: 35359184 DOI: 10.1007/s00405-022-07342-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/07/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Main: To describe 1-year overall survival (OS) after primary or salvage management of head and neck squamous cell carcinoma (HNSCC) invading the common or internal carotid artery (CCA/ICA). Secondary: To assess disease control rate, treatment morbidity, and radio-anatomopathologic correlation. METHODS Retrospective study of 67 patients, treated between 1999 and 2020 for N3bM0 HNSCC invading the CCA/ICA as identified by CT-scan. Tumors that could not have been resected with a complete en-bloc resection sacrificing and reconstructing the CCA/ICA were excluded. Patients were separated into two groups (primary or salvage treatment) and studied according to the type of treatment they received: radiotherapy/radiochemotherapy (RT/RCT), surgery, or systemic therapy (ST). RESULTS For newly treated patients, the 1-year OS was significantly better after RT/RCT (73%) than after surgery (40%, p < 0.0001). In the salvage setting, the 1-year OS after surgery (40%) was better than after ST (14%, statistically suggestive difference with p = 0.0241). Surgery improved cervical control, but distant metastases occurred in more than 50% of cases regardless of treatment. No neurological complication occurred after carotid reconstruction. Perioperative mortality was 7% (1/15). The carotid invasion was confirmed by pathological examination in all five patients with an arterial deformation on CT-scan, in seven among eight patients with CCA/ICA encasement greater than 270°, and in four out of seven patients with CCA/ICA encasement between 180° and 270°. CONCLUSION Neck dissection with carotid resection and reconstruction is technically feasible with acceptable neurovascular morbidity. For newly treated patients, survival is better after RT/RCT. For salvage treatment, surgery could be proposed to selected patients.
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Liu K, Zhang H, Jiang H, Gong S, Lyu X, Yu Z. Oncologic surgical resection with intravascular covered stent placement in patients with carotid artery encased by metastatic cancer-Our experience with 5 patients. Clin Otolaryngol 2021; 47:336-340. [PMID: 34784109 DOI: 10.1111/coa.13893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/24/2021] [Accepted: 11/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Kai Liu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine.,School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Haidong Zhang
- Department of Otolaryngology Head and Neck Surgery, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Huanyu Jiang
- School of Medicine, Southeast University, Nanjing, Jiangsu, China.,Department of Otolaryngology Head and Neck Surgery, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shanchun Gong
- Department of Otolaryngology Head and Neck Surgery, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xianjun Lyu
- Department of Interventional Radiography, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhenkun Yu
- Department of Otolaryngology Head and Neck Surgery, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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López F, Suárez C, Vander Poorten V, Mäkitie A, Nixon IJ, Strojan P, Hanna EY, Rodrigo JP, de Bree R, Quer M, Takes RP, Bradford CR, Shaha AR, Sanabria A, Rinaldo A, Ferlito A. Contemporary management of primary parapharyngeal space tumors. Head Neck 2018; 41:522-535. [PMID: 30549361 DOI: 10.1002/hed.25439] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/19/2018] [Accepted: 07/06/2018] [Indexed: 01/28/2023] Open
Abstract
The parapharyngeal space is a complex anatomical area. Primary parapharyngeal tumors are rare tumors and 80% of them are benign. A variety of tumor types can develop in this location; most common are salivary gland neoplasm and neurogenic tumors. The management of these tumors has improved greatly owing to the developments in imaging techniques, surgery, and radiotherapy. Most tumors can be removed with a low rate of complications and recurrence. The transcervical approach is the most frequently used. In some cases, minimally invasive approaches may be used alone or in combination with a limited transcervical route, allowing large tumors to be removed by reducing morbidity of expanded approaches. An adequate knowledge of the anatomy and a careful surgical plan is essential to tailor management according to the patient and the tumor. The purpose of the present review was to update current aspects of knowledge related to this more challenging area of tumor occurrence.
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Affiliation(s)
- Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Iain J Nixon
- NHS Lothian, University of Edinburgh, Edinburgh, United Kingdom
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Juan Pablo Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Miquel Quer
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Clínica Vida/Instituto de Cancerología Las Américas, Medellín, Colombia
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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