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Pace GM, Morales-Olavarría C, Costantino A, Festa BM, Russo E, Iannella G, Carnevale C, Di Maio P, Sampieri C, Accorona R, De Virgilio A. Survival and complications after carotid resection for head and neck squamous cell carcinoma: A systematic review and pooled analysis. Head Neck 2024; 46:1777-1787. [PMID: 38469988 DOI: 10.1002/hed.27723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/28/2024] [Accepted: 02/24/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE The aim of this study is to analyze oncologic outcomes and complications rate after common or internal carotid artery (CCA/ICA) resection for head and neck squamous cell carcinoma (HNSCC). METHODS This study was conducted in conformity with the PRISMA statement. A systematic review and pooled analysis was performed for overall survival (OS), disease specific survival (DSS) (primary outcomes), and perioperative death rate (secondary outcome). RESULTS A total of 276 patients (males: 76.7%, n = 191/249) with a median age of 59 years (n = 239/276; 95% CI 55.0-61.7) who underwent CCA/ICA resection for HNSCC were included. The median follow-up time was 11 months (n = 276). Estimated pooled OS rates (95% CI) at 1 and 2 years were 52.7% (46.9-59.2) and 29.8% (24.3-36.5), respectively. The median OS (95% CI) was 14 months (12-17). Estimated pooled DSS rates (95% CI) at 1 and 2 years were 58.6% (52.7-65.2) and 34.6% (28.5-41.9), respectively. The median DSS (95% CI) was 16 months (14-19). The perioperative death rate was 6.9% (n = 19/276). CONCLUSIONS CCA/ICA resection should be considered as a treatment option for accurately selected patients. Multicentric prospective studies are recommended to develop a predictive score guiding the decision-making process.
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Affiliation(s)
- Gian Marco Pace
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Andrea Costantino
- Department of Otolaryngology-Head and Neck Surgery, AdventHealth Orlando, Celebration, Florida, USA
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Elena Russo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | | | - Pasquale Di Maio
- Unit of Otorhinolaryngology, Giuseppe Fornaroli Hospital, ASST Ovest Milanese, Milan, Italy
| | - Claudio Sampieri
- Department of Medical Science (DIMES), University of Genoa, Genoa, Italy
- Functional Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
| | - Remo Accorona
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Ferrari M, Zanoletti E, Taboni S, Cazzador D, Tealdo G, Schreiber A, Mattavelli D, Rampinelli V, Doglietto F, Fontanella MM, Buffoli B, Vural A, Verzeletti V, Carobbio ALC, Mardighian D, Causin F, Orlandi E, Cenzato M, Rezzani R, Nicolai P. Resection of the internal carotid artery in selected patients affected by cancer of the skull base. Head Neck 2021; 44:1030-1042. [PMID: 34939715 DOI: 10.1002/hed.26967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/09/2021] [Accepted: 12/10/2021] [Indexed: 11/05/2022] Open
Abstract
Invasion of the internal carotid artery (ICA) has been historically considered a criterion of non-resectability of skull base cancer (SBC). Patients affected by SBC who underwent surgery including resection of ICA at two tertiary institutions were included. Demographics, oncologic, and surgical information, complications, and survival outcomes were retrospectively reviewed. Survival outcomes were calculated. Ten patients were included. Three surgical approaches (transnasal endoscopic, transorbital, and transpetrosal) were employed to resect the invaded/abutted tract(s) of the ICA. All patients underwent ICA temporary balloon occlusion test. In two patients, an extracranial-to-intracranial arterial bypass was harvested. Major neuromorbidity was observed in two patients. Perioperative mortality of the series was 10.0%. Mean overall survival was 27.2 months, with 2-year overall and progression-free survival rate of 88.9%. ICA resection is feasible as part of the ablation performed for very advanced SBCs. Survival outcomes are acceptable in adequately selected patients.
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Affiliation(s)
- Marco Ferrari
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHN, Toronto, Canada.,Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Elisabetta Zanoletti
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Stefano Taboni
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHN, Toronto, Canada.,Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Diego Cazzador
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Giulia Tealdo
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Vittorio Rampinelli
- Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy.,Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Francesco Doglietto
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Marco Maria Fontanella
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alperen Vural
- Department of Otorhinolaryngology, Erciyes University - Faculty of Medicine, Kayseri, Turkey
| | - Vincenzo Verzeletti
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Andrea Luigi Camillo Carobbio
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Dikran Mardighian
- Neuroradiology Unit, "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Francesco Causin
- Section of Neuroradiology, Department of Diagnostic Imaging and Interventional Radiology, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy ("Fondazione CNAO"), Pavia, Italy
| | - Marco Cenzato
- Neurosurgery Unit, Department of Neuroscience, "ASST Grande Ospedale Metropolitano Niguarda", Milan, Italy
| | - Rita Rezzani
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
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Orlandi E, Ferrari M, Lafe E, Preda L, Benazzo M, Vischioni B, Bonora M, Rampinelli V, Schreiber A, Licitra L, Nicolai P. When Everything Revolves Around Internal Carotid Artery: Analysis of Different Management Strategies in Patients With Very Advanced Cancer Involving the Skull Base. Front Oncol 2021; 11:781205. [PMID: 34869033 PMCID: PMC8636461 DOI: 10.3389/fonc.2021.781205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Internal or common carotid artery encasement (CAE) is observed in almost 2-7% of head and neck cancers (HNC) and designates the tumor with the T4b category. This clinical scenario is associated with a dismal prognosis, owing to the risk for thrombosis and bleeding that usually characterizes such an advanced cancer. Standardized radiological criteria to infer invasion of the carotid artery are lacking. Complete surgical resection in the context of a multimodality treatment is supposed to offer the greatest chances of cure. Surgery can either be carotid-sparing or include carotidectomy. Data on probability of cerebrovascular and non-cerebrovascular complications, risk of carotid blowout, poor oncologic outcomes, and less-than-certain efficacy of diagnostic and interventional preventive procedures against cerebral infarction make it difficult to define surgery as the recommended option among other therapeutic strategies. Non-surgical therapies based on radiation therapy possibly combined with chemotherapy are more frequently employed in HNC with CAE. In this context, carotid blowout is the most feared complication, and its probability increases with tumor stage and cumulative radiation dose received by the vessel. The use of highly conformal radiotherapies such as intensity-modulated particle therapy might substantially improve the manageability of HNC with CAE by possibly reducing the risk of late sequalae. Despite evidence is frail, it appears logical that a case-by-case evaluation through multidisciplinary decision making between head and neck surgeons, radiation oncologists, medical oncologists, diagnostic and interventional radiologists, and vascular surgeons are of paramount value to offer the best therapeutic solution to patients affected by HNC with CAE.
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Affiliation(s)
- Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy ("Fondazione CNAO"), Pavia, Italy
| | - Marco Ferrari
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHN, Toronto, ON, Canada.,Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Elvis Lafe
- Department of Diagnostic Radiology and Interventional Radiology and Neuroradiology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Lorenzo Preda
- Department of Diagnostic Radiology and Interventional Radiology and Neuroradiology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Marco Benazzo
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Barbara Vischioni
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy ("Fondazione CNAO"), Pavia, Italy
| | - Maria Bonora
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy ("Fondazione CNAO"), Pavia, Italy
| | - Vittorio Rampinelli
- Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy.,Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Lisa Licitra
- Department of Oncology and Hematology-Oncology, University of Milan, IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
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Zhao J, Liu L, Wei J, Ma D, Geng W, Yan X, Zhu J, Du H, Liu Y, Li L, Chen F. A novel strategy to engineer small-diameter vascular grafts from marrow-derived mesenchymal stem cells. Artif Organs 2011; 36:93-101. [PMID: 21790675 DOI: 10.1111/j.1525-1594.2011.01231.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Tissue-engineered blood vessels have mainly relied on endothelial cells (ECs), smooth muscle cells (SMCs), and biocompatible materials. However, long-term results have revealed several material-related failures, such as stenosis, thromboembolization, and the risk of infection. Furthermore, SMCs from elderly persons have reduced capacity in proliferation and collagen production. Mesenchymal stem cells (MSCs) have the ability to differentiate into multiple cell lineages, including osteoblasts, chondrocytes, ECs, and SMCs. In the current experiment, rabbit MSCs were cultured to form a cell sheet. A tissue-engineered vascular graft (TEVG) was fabricated by rolling the MSC sheet around a mandrel. The TEVG was implanted into a defect of the common carotid artery after it was examined macroscopically and microscopically. Hematoxylin and eosin staining showed that cell sheet was composed of five to seven layers of cells with the thickness of 40-50 µm. Results from the adhesion assay revealed that MSCs had similar antiplatelet adhesion property to ECs. Histological analysis of TEVGs showed that the layers of the cell sheet had fully fused in vitro. After implantation, TEVGs had excellent patency and integrated well with the native vessel. The structure of the TEVGs was similar to that of the native artery 4 weeks after implantation. Electron microscopy showed that the implanted TEVGs endothelialized. These results indicated that a completely biological TEVG could be assembled with autologous MSCs. These TEVGs are useful for revascularization in humans, which would reduce the occurrence of complications caused by foreign materials.
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Affiliation(s)
- Jie Zhao
- Key Lab of Resource Biology and Biotechnology in Western China, Ministry of Education, Northwest University, Xi' an, China
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6
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Midline mandibulotomy and interposition grafting for lesions involving the internal carotid artery below the skull base. J Vasc Surg 2009; 49:86-92. [DOI: 10.1016/j.jvs.2008.08.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 08/09/2008] [Accepted: 08/17/2008] [Indexed: 11/22/2022]
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The impact of surgery in the management of the head and neck carcinoma involving the carotid artery. Laryngoscope 2008; 118:1771-4. [PMID: 18724260 DOI: 10.1097/mlg.0b013e31817f6dc7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES/HYPOTHESIS To demonstrate the feasibility of the carotid artery dissection and/or resection and reanastomosis, and to show its positive impact on survival and disease control rates for the head and neck carcinomas involving the carotid artery. STUDY DESIGN Tertiary center (Comprehensive Cancer Center). Case series review. METHODS The data of 90 patients with head and neck malignancies involving the carotid artery were operated for the carotid artery dissection and/or resection, and reanastomosis in the last 10 years were retrospectively reviewed and analyzed. RESULTS Eighty (89%) of the 90 patients' head and neck malignancies were squamous cell carcinoma. Fifty-two (65%) and 28 (35%) of 80 patients were recurrent and stage IV disease, respectively. There was no stage I to III disease. Carotid artery was dissected and preserved in 64 (71.1%) of the 90 patients. Eighteen (20%) of 90 patients needed carotid artery dissection with resection and reanastomosis. Eight (8.9%) patients were unresectable. Sixty (75%) of 80 patients needed reconstruction with regional or free flaps and grafts. Overall 2- and 5-year estimated survivals were 32.4% and 27.8% for all; 14.3% and 10.7% for recurrent; 64.3% and 57.8% for stage IV previously untreated; and 22.0% and 22.0% for carotid artery resected-reanastomosed patients, respectively. CONCLUSIONS The carotid artery dissection without resection is an achievable goal in majority of patients with the advanced stage head and neck carcinoma involving the carotid artery. Resection and reanastomosis of carotid artery, especially in the previously untreated carotid involved patients, is a feasible surgery and achieves better survival and disease control rates when compared with the unresected or recurrent disease patients.
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Froelich SC, Abdel Aziz KM, Levine NB, Pensak ML, Theodosopoulos PV, Keller JT. Exposure of the Distal Cervical Segment of the Internal Carotid Artery Using the Trans-spinosum Corridor: Cadaveric Study of Surgical Anatomy. Oper Neurosurg (Hagerstown) 2008; 62:ONS354-61; discussion ONS361-2. [DOI: 10.1227/01.neu.0000326019.30058.7b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background:
Exposure of the most distal portion of the cervical segment of the internal carotid artery (ICA) is technically challenging. Previous descriptions of cranial base approaches to expose this segment noted facial nerve manipulation, resection of the glenoid fossa, and significant retraction or resection of the condyle. We propose a new approach using the frontotemporal orbitozygomatic approach to expose the distal portion of the cervical segment of the ICA via the trans-spinosum corridor.
Methods:
Six formalin-fixed injected heads were used for cadaveric dissection. Two blocs containing the carotid canal and surrounding region were used for histological examination.
Results:
The ICA lies immediately medial to the vaginal process. The carotid sheath attaches laterally to the vaginal process. With use of the trans-spinosum corridor, the surgeon's line of sight courses in front of the temporomandibular joint, through the foramen spinosum, spine of the sphenoid, and vaginal process. Removal of the vaginal process exposes the vertical portion of the petrous segment of the ICA. The loose connective tissue space between the adventitia and the carotid sheath is easily entered from above. Incision of the carotid sheath exposes the ICA without disruption of the temporomandibular joint.
Conclusion:
Control of the cervical segment of the ICA can be critical when dealing with cranial base tumors that invade or surround the petrous segment of the ICA. This novel technique through the trans-spinosum corridor can effectively expose the distal portion of the cervical segment of the ICA without causing manipulation of the facial nerve and while maintaining the integrity of the temporomandibular joint.
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Affiliation(s)
- Sebastien C. Froelich
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Khaled M. Abdel Aziz
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Nicholas B. Levine
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Myles L. Pensak
- The Neuroscience Institute, Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Philip V. Theodosopoulos
- The Neuroscience Institute, Department of Neurosurgery, University of Cincinnati College of Medicine and Mayfield Clinic, Cincinnati, Ohio
| | - Jeffrey T. Keller
- The Neuroscience Institute, Department of Neurosurgery, University of Cincinnati College of Medicine and Mayfield Clinic, Cincinnati, Ohio
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Abstract
Skull base tumors involving the carotid artery pose a difficult surgical challenge. The potential for bypass grafting for cerebral revascularization carries inherent risks but may aid in tumor resection and control in those who warrant carotid sacrifice but have inappropriate natural cerebrovascular reserve. We include a review of the literature discussing the indications for carotid resection as part of skull base tumor surgery, indications for cerebral revascularization, balloon test occlusion, graft types and operative technique, complications, and results.
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Choi EC, Lim YC, Lee SY, Lim JY, Kim SH. Titanium hemostatic clip tailoring method to overcome vessel caliber discrepancy in interposition saphenous vein graft for carotid artery resection. Acta Otolaryngol 2005; 125:638-41. [PMID: 16076713 DOI: 10.1080/00016480410025207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONCLUSION This method makes it possible to perform the ISVG simply and within a short time and, therefore, is very useful for shortening the duration to block circulation. OBJECTIVE Complete excision of a malignant tumor which invades carotid artery walls essentially requires the resection and reconstruction of the carotid artery. In most cases, an interposition graft using a saphenous vein has been performed; however, the discrepancy in vessel caliber between the common carotid artery and the saphenous vein can complicate the surgical technique. We have introduced and evaluated a new titanium hemostatic clip tailoring method to overcome the vessel caliber discrepancy in interposition saphenous vein graft (ISVG) for carotid artery resection in the treatment of head and neck cancers. MATERIAL AND METHODS After carotid artery resection, the calibers of the proximal common carotid artery and the vein were compared, and the size of the orifice of the common carotid artery was gradually reduced to a little larger than or the same as that of the vein using a titanium hemostatic clip. Subsequently, the common carotid artery was connected to the vein by means of anastomosis. The same method was also applied to the distal anastomosis site. Thereafter, the vessels were connected through the anastomosis, and circulation was restored by releasing a vascular clamp. Then, the redundant portion on the outside of the carotid artery was sutured by means of the blanket-edge suture method, using 6-0 Prolene. RESULTS We employed this method in two patients with recurrent squamous cell carcinoma and neuroblastoma, respectively. The ISVG of these patients was found to maintain good patency at follow-up angiography after 1 year, and no specific vascular complications were observed.
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Affiliation(s)
- Eun Chang Choi
- College of Medicine, Yonsei University, Department of Otorhinolaryngology, Seoul, South Korea
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Abstract
Management options for patients with advanced neck node metastasis from head and neck cancer are controversial. Typically, N3 disease suggests a poor outcome because of difficulty with regional control and the high likelihood of distant metastases. Patients who are treated for cure are treated with aggressive multimodality treatment. Therefore, a critical assessment of the potential for cure or measurable palliation, patient comorbidity, and the risk of complications when considering treatment for patients with N3 disease figures prominently in treatment planning. The pretreatment evaluation and contemporary management of patients with N3 disease are discussed in this review.
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Affiliation(s)
- Karen T Pitman
- Department of Otolaryngology and Communicative Sciences, The University of Mississippi Medical Center, Jackson, Mississippi, USA
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Feiz-Erfan I, Han PP, Spetzler RF, Lanzino G, Ferreira MAT, Gonzalez LF, Porter RW. Salvage of advanced squamous cell carcinomas of the head and neck: internal carotid artery sacrifice and extracranial–intracranial revascularization. Neurosurg Focus 2003; 14:e6. [PMID: 15709723 DOI: 10.3171/foc.2003.14.3.7] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Squamous cell carcinoma (SCC) of the head and neck may involve the carotid artery (CA) in the neck or skull base. Whether tumor resection should be associated with sacrifice of the CA is debatable.
Methods
Records obtained in five consecutive patients (three men, and two women; mean age 58 years, range 47–69 years) treated for recurrent or progressive SCC involving the internal carotid artery (ICA) at the skull base were reviewed retrospectively. The ICA was sacrificed, an extracranial–intracranial (EC–IC) bypass was performed using a saphenous vein graft, and the tumor and involved ICA segment were resected.
Gross-total resection of the SCC was achieved in four cases. One patient died of an acute postoperative stroke due to bypass occlusion and did not undergo tumor resection. No other permanent ischemic or neurological deficits were noted. The other four patients died of tumor progression (survival range 2–40 months, mean 14 months). One patient survived for more than 2 years (2-year overall survival rate 20%). Histological tumor invasion of the CA wall was verified in one of the three evaluated specimens.
Conclusions
A high rate of morbidity and mortality is associated with cases in which skull base CA sacrifice and an EC–IC bypass are performed. Not all resected arteries are shown to have malignant infiltration on histological examination. Better preoperative imaging criteria are needed to define malignant infiltration of the ICA at the skull base. Chemotherapy and radiotherapy without aggressive tumor resection may be an option for these patients.
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Affiliation(s)
- Iman Feiz-Erfan
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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