Carotid reconstruction in patients operated for malignant head and neck neoplasia.
BACKGROUND
Patients with malignant head and neck neoplasia may present simultaneous involvement of large vessels due to the growth of the tumoral mass. The therapeutic options are chemotherapy, radiotherapy, surgery or combined treatments.


OBJECTIVE
To analyze the result of surgical treatment with carotid reconstruction in patients with advanced malignant head and neck neoplasia.


METHODS
Prospective.


METHODS
Hospital do Câncer A.C. Camargo, São Paulo, Brazil.


METHODS
Eleven patients operated because of advanced malignant head and neck neoplasia that was involving the internal and/or common carotid artery.


METHODS
By means of clinical examination, outpatient follow-up and duplex scanning, we analyzed the patency of the carotid grafts, vascular and non-vascular complications, disease recurrence and survival of the patients.


RESULTS
Six patients (54.5%) did not present any type of complication. There was one vascular complication represented by an occlusion of the carotid graft with a cerebrovascular stroke in one hemisphere. Non-vascular complications occurred in five patients (45.5%). During the follow-up, eight patients died (72.7%), of whom seven had loco-regional tumor recurrence and one had pulmonary and hepatic metastases (at an average of 9 months after the operation). Seven of these patients presented functioning grafts. The three patients still alive have no tumor recurrence and their grafts are functioning (an average of 9 months has passed since the operation).


CONCLUSIONS
Patients with advanced malignant head and neck neoplasia involving the carotid artery that are treated surgically present a prognosis with reservations. When the internal and/or common carotid artery is resected en-bloc with the tumor, arterial reconstruction must be performed. The long saphenous vein is a suitable vascular substitute.
Nishinari
Kenji
K
Departamento de Cirurgia Vascular, Hospital do Câncer A.C. Camargo, São Paulo, Brazil. marken@uol.com.br
Wolosker
Nelson
N
Yazbek
Guilherme
G
Malavolta
Luiz Caetano
LC
Zerati
Antônio Eduardo
AE
Kowalski
Luiz Paulo
LP
D000328:Adult; D000368:Aged; D002339:Carotid Arteries / Q000601:surgery*; D018572:Disease-Free Survival; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome