Carotid interposition in patients with head and neck tumors: clinical experience of 13 cases reconstructed with a great saphenous vein autograft

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.

Chinese Abstract

背景：颈动脉介入移植（CIG）手术对于头颈癌（HNC）是一种罕见的手术, 文献描述的病例数量是有限的。

目的：评估赫尔辛基大学医院的手术结果。

材料和方法：回顾性分析了15年内在头颈部肿瘤手术中接受 CIG 的患者, 计算了直至2020 年 5月1日的总生存期 (OS)。主要结果是测量 30 天 总生存期、术后卒中率和其他并发症。次要结果是测量1年、2年和 5年总生存期 。

结果：确认了13名患者, 其中11名患有头颈癌, 2名患有 Shamblin III 颈动脉体肿瘤。大隐静脉用于所有血管重建, 并按常规进行分流。 30天卒中发病率为零。遇到了两次移植爆喷, 其中一次导致死亡, 另一次被成功控制。对于头颈癌患者, 局部区域复发率为36%。 5年总生存期为46.2%。

结论与意义：针对头颈癌的 颈动脉介入移植可实现肿瘤控制, 且并发症发生率可接受。关闭期间的常规分流、肝素化和血压升高似乎是围手术期维持脑循环的安全方案。应考虑中度移植爆喷风险。

Keywords:

• Carotid interposition graft
• carotid artery reconstruction
• head and neck cancer
• surgery

Acknowledgment

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Disclosure statement

No potential conflict of interest was reported by the author(s).