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Luna-Ortiz K, Bautista-Pérez IJ, Luna-Peteuil Z, Martinez-Hernandez HJ. Carotid Artery Resection and Reconstruction due to Benign and Malignant Head and Neck Tumors. Indian J Otolaryngol Head Neck Surg 2023; 75:4216-4222. [PMID: 37974813 PMCID: PMC10645706 DOI: 10.1007/s12070-023-04068-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/06/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Carotid resection for head and neck cancer is rare, and serious complications may arise since such cancer is frequently detected in advanced stages. The objective is to describe nine cases of carotid artery resection and reconstruction due to tumor invasion. METHODS The clinical records of nine patients who underwent carotid resection and reconstruction at our hospital were retrospectively reviewed. Carotid body tumors were evaluated with the aid of a vascular team in case carotid resection was necessary at the time of surgery. CT angiography to determine the status of the circle of Willis was performed in all patients who might undergo carotid resection and reconstruction in case of failure to restore cerebral blood flow and thus reduce possible sequelae due to ligation. RESULTS Of nine patients, 6 had carotid body tumors, 1 had a thyroid tumor of conglomerate lymph nodes, 1 had a larynx tumor of conglomerate lymph nodes, and 1 had a myofibroblastic tumor. There were no intraoperative cerebrovascular accidents. One patient (11.1%) had a cerebrovascular accident secondary to carotid hematoma in the intermediate postoperative period that required vascular graft removal. One patient (11.1%) died seven days after surgery following an ischemic cerebrovascular accident. Eight patients remain asymptomatic, and 1 patient with recurrence and metastasis. CONCLUSIONS Carotid resection remains a controversial issue in the treatment of advanced head and neck cancer. However, carotid resection and reconstruction are required for disease control, and complications such as thrombosis or vascular accidents may arise. Fortunately, this is a rare condition. We recommend carotid reconstruction for all patients in whom resection is required for tumor control. Ligation should be a last resort, as seen in the management of one of our patients.
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Affiliation(s)
- Kuauhyama Luna-Ortiz
- Department of Head and Neck Surgery, Instituto Nacional de Cancerología, Av San Fernando #22 Col. Sección XVI, Mexico City, 14080 Tlalpan Mexico
- Department of General Surgery (Head and Neck Surgery, Hospital General “Manuel Gea Gonzalez”, Mexico City, México
| | - Irvint Joel Bautista-Pérez
- Department of Head and Neck Surgery, Instituto Nacional de Cancerología, Av San Fernando #22 Col. Sección XVI, Mexico City, 14080 Tlalpan Mexico
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Guo Y, Pang MCY, Teo CEH, Chng JK. Carotid Artery Involvement in Advanced Recurrent Head and Neck Cancer: A Case Report and Literature Review. Ann Vasc Surg 2018; 56:355.e11-355.e15. [PMID: 30500657 DOI: 10.1016/j.avsg.2018.09.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/29/2018] [Accepted: 09/14/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Surgical management of advanced head and neck tumors involving the carotid artery remains controversial with compromised survival outcomes and heightened risks of morbidity and mortality. CASE We describe a case of a 74-year-old lady with previous T1N0M0 left tongue squamous cell carcinoma, who developed a left nodal recurrence encasing the left external carotid artery from the carotid bifurcation. She underwent an extended left radical neck dissection with carotid artery patch plasty and remains well to date, 10 months after surgery. DISCUSSION Head and neck tumor recurrences are not uncommon, and radical resection of advanced tumors involving the carotid artery is increasingly performed. Various carotid interventions including tumor peeling, ligation, and resection with reconstruction were reported with differences in survival outcomes, morbidity and mortality. CONCLUSION An aggressive surgical approach to advanced tumors involving the carotid artery may be a viable attempt for survival prolongation but requires proper case selection and has to be weighed against the risks of complications to better optimize patient outcomes.
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Affiliation(s)
- Yuxin Guo
- Department of Vascular Surgery, Singapore General Hospital, Singapore.
| | - Maria Cui-Ying Pang
- Department of Otolaryngology, Head and Neck Surgery, Singapore General Hospital, Singapore
| | - Constance Ee-Hoon Teo
- Department of Otolaryngology, Head and Neck Surgery, Singapore General Hospital, Singapore
| | - Jack Kian Chng
- Department of Vascular Surgery, Singapore General Hospital, Singapore
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Bäck LJJ, Aro K, Tapiovaara L, Vikatmaa P, de Bree R, Fernández-Álvarez V, Kowalski LP, Nixon IJ, Rinaldo A, Rodrigo JP, Robbins KT, Silver CE, Snyderman CH, Suárez C, Takes RP, Ferlito A. Sacrifice and extracranial reconstruction of the common or internal carotid artery in advanced head and neck carcinoma: Review and meta-analysis. Head Neck 2018; 40:1305-1320. [PMID: 29405536 DOI: 10.1002/hed.25093] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/21/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Sacrifice and reconstruction of the carotid artery in cases of head and neck carcinoma with invasion of the common or internal carotid artery is debated. METHODS We conducted a systematic search of electronic databases and provide a review and meta-analysis. RESULTS Of the 72 articles identified, 24 met the inclusion criteria resulting in the inclusion of 357 patients. The overall perioperative 30-day mortality was 3.6% (13/357). Permanent cerebrovascular complications occurred in 3.6% (13/357). Carotid blowout episodes were encountered in 1.4% (5/357). The meta-regression analysis showed a significant difference in 1-year overall survival between reports published from 1981-1999 (37.0%) and 2001-2016 (65.4%; P = .02). CONCLUSION This review provides evidence that sacrifice with extracranial reconstruction of common or internal carotid artery in selected patients with head and neck carcinoma may improve survival with acceptable complication rates. However, all of the published literature is retrospective involving selected series and, therefore, precludes determining the absolute effectiveness of the surgery.
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Affiliation(s)
- Leif J J Bäck
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Laura Tapiovaara
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Pirkka Vikatmaa
- Department of Vascular Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Luiz P Kowalski
- Department Otorhinolaryngology - Head and Neck Surgery, Centro de Tratamento e Pesquisa, Hospital do Cancer A.C. Camargo, São Paulo, Brazil
| | - Iain J Nixon
- Department of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh, Scotland
| | | | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, IUOPA, ISPA, CIBERONC, Oviedo, Spain
| | - K Thomas Robbins
- Division of Otolaryngology - Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Robert P Takes
- Department of Otolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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Kyrgias G, Hajiioannou J, Tolia M, Kouloulias V, Lachanas V, Skoulakis C, Skarlatos I, Rapidis A, Bizakis I. Intraoperative radiation therapy (IORT) in head and neck cancer: A systematic review. Medicine (Baltimore) 2016; 95:e5035. [PMID: 27977569 PMCID: PMC5268015 DOI: 10.1097/md.0000000000005035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Multimodality therapy constitutes the standard treatment of advanced and recurrent head and neck cancer. Since locoregional recurrence comprises a major obstacle in attaining cure, the role of intraoperative radiation therapy (IORT) as an add-on in improving survival and local control of the disease has been investigated. IORT allows delivery of a single tumoricidal dose of radiation to areas of potential residual microscopic disease while minimizing doses to normal tissues. Advantages of IORT include the conformal delivery of a large dose of radiation in an exposed and precisely defined tumor bed, minimizing the risk of a geographic miss creating the potential for subsequent dose reduction of external beam radiation therapy (EBRT). This strategy allows for shortening overall treatment time and dose escalation. The aim of this review is to summarize recent published work on the use of IORT as an adjuvant modality to treat common head and neck cancer in the primary or recurrent setting. METHODS We searched the Medline, Scopus, Ovid, Cochrane, Embase, and ISI Web of Science databases for articles published from 1980 up to March 2016. RESULTS Based on relevant publications it appears that including IORT in the multimodal treatment may contribute to improved local control. However, the benefit in overall survival is not so clear. CONCLUSION IORT seems to be a safe, promising adjunct in the management of head and neck cancer and yet further well organized clinical trials are required to determine its role more precisely.
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Affiliation(s)
| | - Jiannis Hajiioannou
- Department of Otolaryngology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Thessaly
| | - Maria Tolia
- Department of Radiotherapy/Radiation Oncology
| | - Vassilios Kouloulias
- 2nd Department of Radiology-Radiotherapy Unit, ATTIKON University Hospital, Medical School, University of Athens
| | - Vasileios Lachanas
- Department of Otolaryngology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Thessaly
| | - Charalambos Skoulakis
- Department of Otolaryngology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Thessaly
| | - Ioannis Skarlatos
- Hellenic Anticancer Institute, St-Savvas Anticancer Hospital, Athens, Greece
| | - Alexandros Rapidis
- Hellenic Anticancer Institute, St-Savvas Anticancer Hospital, Athens, Greece
| | - Ioannis Bizakis
- Department of Otolaryngology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Thessaly
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Tumour–node–metastasis staging of human papillomavirus negative upper aerodigestive tract cancers: a critical appraisal. J Laryngol Otol 2015; 129:1148-55. [DOI: 10.1017/s0022215115002686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:The tumour–node–metastasis staging system has a dynamic structure that is continuously being updated as scientific data develops. This review discusses some suggested revisions on tumour–node–metastasis staging of human papillomavirus negative upper aerodigestive tract cancers.Methods:The seventh edition of The American Joint Committee on Cancer Staging Manual was reviewed and important issues that could be considered for revision were identified and discussed.Results:According to our assessment of the oncological outcomes of previous studies, the following factors should be considered for revision: anterior commissure involvement and subglottic extension in laryngeal cancers; underlying bone involvement in hard palate and upper alveolar ridge cancers; tumour thickness in oral cancers; and extracapsular spread and carotid artery involvement in neck metastases.Conclusion:Sufficient data on the prognostic importance of these issues have been reported. Suggested revisions in line with current knowledge on the clinical behaviour of upper aerodigestive tract cancers would improve the relevancy of staging.
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Chung EJ, Kwon KH, Yoon DY, Cho SW, Kim EJ, Rho YS. Clinical outcome analysis of 47 patients with advanced head and neck cancer with preoperative suspicion of carotid artery invasion. Head Neck 2015; 38 Suppl 1:E287-92. [DOI: 10.1002/hed.23987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University, College of Medicine; Seoul Korea
| | - Kee-Hwan Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery; Ilsong Memorial Institute of Head and Neck Cancer, Hallym University, College of Medicine; Seoul Korea
| | - Dae-Young Yoon
- Department of Radiology; Hallym University, College of Medicine; Seoul Korea
| | - Sung-Woo Cho
- Department of Thoracic and Cardiovascular Surgery; Hallym University, College of Medicine; Seoul Korea
| | - Eung-Joong Kim
- Department of Thoracic and Cardiovascular Surgery; Hallym University, College of Medicine; Seoul Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology-Head and Neck Surgery; Ilsong Memorial Institute of Head and Neck Cancer, Hallym University, College of Medicine; Seoul Korea
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Zeidan YH, Yeh A, Weed D, Terry C, Freeman S, Krowiak E, Borrowdale R, Huntley T. Intraoperative radiation therapy for advanced cervical metastasis: a single institution experience. Radiat Oncol 2011; 6:72. [PMID: 21676211 PMCID: PMC3141525 DOI: 10.1186/1748-717x-6-72] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 06/15/2011] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The purpose of this study is to review our experience with the use of IORT for patients with advanced cervical metastasis. METHODS Between August 1982 and July 2007, 231 patients underwent neck dissections as part of initial therapy or as salvage treatment for advanced cervical node metastases resulting from head and neck malignancies. IORT was administered as a single fraction to a dose of 15 Gy or 20 Gy in most pts. The majority was treated with 5 MeV electrons (112 pts, 50.5%). RESULTS 1, 3, and 5 years overall survival (OS) after surgery + IORT was 58%, 34%, and 26%, respectively. Recurrence-free survival (RFS) at 1, 3, and 5 years was 66%, 55%, and 49%, respectively. Disease recurrence was documented in 83 (42.8%) pts. The majority of recurrences were regional (38 pts), as compared to local recurrence in 20 pts and distant failures in 25 pts. There were no perioperative fatalities. CONCLUSIONS IORT results in effective local disease control at acceptable levels of toxicity. Our results support the initiation of a phase III trial comparing outcomes for patients with cervical metastasis treated with or without IORT.
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Affiliation(s)
- Youssef H Zeidan
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA.
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