title: Late surgical outcomes of carotid resection and saphenous vein graft revascularization in patients with advanced head and neck squamous cell carcinoma.
abstract: BACKGROUND
  In head and neck squamous cell carcinoma, invasion of the carotid artery is a severe mortality predictor. We report an updated experience of 19 patients who underwent head and neck resection for squamous cell carcinoma with concomitant carotid reconstruction. This study aims to analyze overall survival rates, primary patency of the reconstructions, vascular and nonvascular complications, radiotherapy dosing as well as late follow-up and outcomes.
  
  
  METHODS
  From September 1997 to 2011, 19 patients with advanced squamous cell carcinoma with carotid artery invasion were submitted to resection and concomitant vascular reconstruction in a single referred oncological institution. Patient follow-up was done by means of periodic outpatient returns, where clinical and duplex scan evaluations were performed to study graft patency.
  
  
  RESULTS
  The average length of follow-up was 23.3 (± 34.4) months. Nonvascular complications occurred in 6 patients (31.6%). Only 1 (5.3%) vascular complication was observed, resulting from the immediate occlusion of the carotid graft. All patients were submitted to preoperative, adjuvant, or curative intent radiotherapy during the course of the oncologic treatment, with varying doses. Overall disease-free survival, primary patency, and survival with patent graft rates in 5 years are respectively 12.9%, 93.1%, and 13.0%. Three patients (15.9%) are still alive, all without tumor recurrence, and present a disease-free long-term follow-up with patent grafts 21 months, 68 months, and 151 months after surgery.
  
  
  CONCLUSIONS
  Aggressive surgical approach for patients with advanced squamous cell head and neck carcinoma with carotid invasion can lead to cure in a select group of patients. Saphenous vein grafts demonstrated favorable outcomes with low infection and high patency rates, suggesting a valid alternative for arterial reconstruction in these cases.
authors.affiliation: Division of Vascular and Endovascular Surgery, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Kenji
authors.initials: K
authors.lastname: Nishinari
authors.affiliation: Division of Vascular and Endovascular Surgery, AC Camargo Cancer Center, São Paulo, Brazil. Electronic address: mari.krutman@ig.com.br.
authors.forename: Mariana
authors.initials: M
authors.lastname: Krutman
authors.affiliation: Division of Vascular and Endovascular Surgery, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Luisa Assis
authors.initials: LA
authors.lastname: Valentim
authors.affiliation: Division of Head and Neck Surgery, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Thiago Celestino
authors.initials: TC
authors.lastname: Chulam
authors.affiliation: Division of Vascular and Endovascular Surgery, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Yazbek
authors.affiliation: Division of Head and Neck Surgery, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Luiz Paulo
authors.initials: LP
authors.lastname: Kowalski
authors.affiliation: Division of Vascular and Endovascular Surgery, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: Wolosker
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012501:Saphenous Vein / Q000637:transplantation*; D015996:Survival Rate; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency; D014656:Vascular Surgical Procedures