Essential Site Maintenance: Authorea-powered sites will be updated circa 15:00-17:00 Eastern on Tuesday 5 November.
There should be no interruption to normal services, but please contact us at [email protected] in case you face any issues.

loading page

Oncologic surgical resection with intravascular covered stent placement in patients with carotid artery encased by metastatic cancer---Our experience with 5 patients
  • +3
  • Kai Liu,
  • Haidong Zhang,
  • Huanyu Jiang,
  • Shanchun Gong,
  • Xianjun Lyu,
  • Zhenkun Yu
Kai Liu
Southeast University

Corresponding Author:[email protected]

Author Profile
Haidong Zhang
The Affiliated BenQ Hospital of Nanjing Medical University
Author Profile
Huanyu Jiang
Southeast University
Author Profile
Shanchun Gong
The Affiliated BenQ Hospital of Nanjing Medical University
Author Profile
Xianjun Lyu
The Affiliated BenQ Hospital of Nanjing Medical University
Author Profile
Zhenkun Yu
Southeast University
Author Profile

Abstract

Importance: Tumor encasement of the common carotid artery (CCA) and/or the internal carotid artery (ICA) in patients with advanced head and neck tumors represents a significant surgical challenge. At present, there are few reports on the treatment approach that can achieve the maximal oncological resection and reduce the difficulty of operation without affecting the carotid artery blood flow. Objective: To examine whether the combination of oncologic complete tumor resection and intravascular covered stent placement is more advantageous in the management of advanced head and neck cancer. Design, Setting, and Participants: Five patients with advanced head and neck squamous cell carcinoma (AHNSCC) invading one side of the carotid artery were retrospectively enrolled. The contrast-enhanced computed Tomography (CT) and angiography were performed to assess the severity of extrinsic tumor compression to the carotid artery. Covered stent was placed intra-arterially at least 1 cm proximal and distal beyond the area of tumor involvement. The tumor and the involved carotid artery were resected, and pectoralis major flap transfer was utilized for coverage of the great vessels supported with intra-arterial covered stent. Main Outcomes and Measures: Efficacy of oncologic complete tumor resection combined with endovascular stent placement. Results: The post-stenting demonstrated an improvement in the appearance and caliber of the affected carotid artery. Four patients experienced transient bradycardia and hypotension. All five patients underwent R0 resection. Postoperatively, the flap all had rich vascularity and healing. Three patients underwent adjuvant radiotherapy or chemoradiation. With median follow-up 6.5 months, one patient died of multiple organ failures at 6.5 months after surgery; one patient developed tracheal stoma recurrence and treated with salvaged surgery; the three other patients had no disease recurrence in their last follow-ups. Conclusions and Relevance: Surgical resection with intravascular covered stent placement could potentially achieve the maximal oncological resection without compromise carotid artery blood flow in patients with carotid artery encased head and neck cancer.
01 Apr 2021Submitted to Clinical Otolaryngology
08 Apr 2021Submission Checks Completed
08 Apr 2021Assigned to Editor
15 Apr 2021Reviewer(s) Assigned
13 Aug 2021Review(s) Completed, Editorial Evaluation Pending
12 Sep 2021Editorial Decision: Revise Major
24 Oct 20211st Revision Received
25 Oct 2021Submission Checks Completed
25 Oct 2021Assigned to Editor
05 Nov 2021Review(s) Completed, Editorial Evaluation Pending
07 Nov 2021Editorial Decision: Accept
Mar 2022Published in Clinical Otolaryngology volume 47 issue 2 on pages 336-340. 10.1111/coa.13893