Outcome of carotid and subclavian blowout syndrome in patients with pharynx- and larynx carcinoma passing a standardized multidisciplinary treatment

Abstract

Background: Carotid blowout syndrome (CBS) is one of the most feared emergencies in the head and neck surgery and tends to occur in patients with head and neck cancer, wound complications, pharyngocutaneous fistulas, or after radio(chemo)therapy. CBS is always life threatening and associated with a 50% mortality/morbidity rate.

Methods: Between 2007 and 2015, a total of 51 patients who developed CBS caused by the tumour masses or after radio(chemo)therapy were included. All patients underwent a standardised bleeding management.

Results: In 86% of patients, CBS was associated with manifest carcinoma. Fifty three percent of patients were treated by transcervical surgery, in 36% of these cases surgery was supplemented by endovascular approaches. Severe complications such as re-bleeding or cerebral ischemia occurred infrequently. Seven patients died because of the acute bleeding.

Conclusion: CBS associated with head and neck cancer carries poor mid and long-term prognoses. An interdisciplinary standardised treatment path dramatically reduced overall morbidity and mortality.

Chinese abstract

背景：颈动脉痉挛综合症（CBS）是头颈部手术中最令人担忧的紧急状况之一, 往往发生于头颈部肿瘤患者、伤口并发症患者、咽旁瘘患者或放化疗之后。 CBS总是威胁到生命, 具50%的死亡率/发病率。

方法：该研究纳入2007年至2015年间, 51例由肿瘤肿块引起的或放疗（化疗）后发生的CBS患者。所有患者都接受了标准化的出血处理。

结果：在86%的患者中, CBS与明显的癌相关。百分之五十三的患者接受经颈部手术治疗, 其中36%的患者的手术辅以血管内疗法。经常出现再次出血或脑缺血等严重并发症。七名患者因急性出血而死亡。

结论：与头颈部肿瘤相关CBS的中长期预后较差。跨学科的标准化治疗途径大大降低了它的整体发病率和死亡率。

Keywords:

• Carotid artery blow out
• bleeding
• head and neck squamous cell carcinoma
• therapy
• outcome

Disclosure statement

All authors disclose any financial or intellectual conflict of interest.