[Is carotid resection a valuable option in advanced head and neck squamous cell carcinomas].
Head and neck squamous cell carcinomas may involve the carotid artery. Surgical treatment of these tumors is a difficult challenge, because of related morbidity and mortality. The aim of this study of international literature was to define the best preoperative and intraoperative strategy which permits carotid resection with acceptable neurologic risk. Pre-operative evaluation of cerebral tolerance to carotid occlusion is performed. If the patient has successfully completed the 30-minute temporary occlusion of the internal carotid artery, a permanent balloon occlusion is performed. Surgical treatment includes carotid resection with or without revascularization using an autogenous graft. Elective carotid resection without reconstruction results in cerebral complications in 0 to 25% of patients, and death in 0 to 30% of patients. If a reconstruction using a graft is performed, cerebral complications occur in 0 to 22% of patients, and death in 0 to 33% of patients. Anastomotic rupture occurs in 0 to 33% of patients. However, many authors reported no neurologic complications and no deaths after performing successful preoperative permanent balloon occlusion of the internal carotid associated with carotid resection. Carotid resection can be performed with an acceptable cerebral risk in selected patients. Preoperative carotid occlusion seems to result in decreased postoperative mortality and morbidity rates. Prospective studies should be done to clarify the benefit of this procedure.
Verhaeghe
Jean-Luc
JL
Département de chirurgie, Centre de lutte contre le cancer Alexis-Vautrin, avenue de Bourgogne, 54511 Vandoeuvre-lès-Nancy, France. jl.verhaeghe@nancy.fnclcc.fr
Montagne
Serge
S
Belotzerkovski
Igor
I
Bracard
Serge
S
Henneton
Catherine
C
Lapeyre
Michel
M
Meistelman
Claude
C
Dolivet
Gilles
G
D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000473:pathology / Q000601:surgery*; D002342:Carotid Artery, External / Q000473:pathology / Q000601:surgery; D002343:Carotid Artery, Internal / Q000473:pathology / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D009361:Neoplasm Invasiveness; D018579:Patient Selection; D014690:Venous Pressure
La résection carotidienne constitue-t-elle une option thérapeutique dans les carcinomes épidermoïdes évolués cervico-faciaux?