Oncologic surgical resection with intravascular covered stent placement
in patients with carotid artery encased by metastatic cancer---Our
experience with 5 patients
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.