title: Carotid Artery Sacrifice and Reconstruction in the Setting of Advanced Head and Neck Cancer.
abstract: OBJECTIVE
  To determine oncological and neuromorbidity outcomes in patients with advanced head and neck cancer (stage IVB) requiring sacrifice and reconstruction of the carotid artery.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary care referral center.
  
  
  METHODS
  Overall, 51 patients underwent carotid artery sacrifice during surgical treatment of the neck, in both the primary and salvage setting. All patients underwent autogenous in-line carotid artery bypass grafting with either saphenous vein or the deep femoral vein in conjunction with vascular surgery. In all, the study included 39 males and 12 female subjects, with age ranging from 39 to 82 (mean, 62.7).
  
  
  RESULTS
  Two patients (3.9%) had a cerebral vascular accident in the immediate postoperative period. The remaining 49 patients (96%) had no neurologic sequela. Serial ultrasonic evaluation revealed 4 patients with intra-luminal thrombus within the site of reconstruction. Perioperative mortality occurred in a single patient. Disease-related mortality occurred in 9.8% (5) of patients, with an overall 2-year survival of 82%.
  
  
  CONCLUSIONS
  We presently report the largest series of surgical treatment for advanced head and neck cancer with carotid artery involvement. We document an overall 2-year survival of 82% in the setting of low perioperative neuromorbidity and mortality rates. We therefore consider carotid artery sacrifice and autogenous vein graft reconstruction in the absence of distant metastatic disease as a viable treatment option for what was once thought to be a palliative procedure.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, New York Eye and Ear Infirmary of Mt. Sinai, New York, New York, USA.
authors.forename: Moustafa
authors.initials: M
authors.lastname: Mourad
authors.affiliation: Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA.
authors.forename: Masoud
authors.initials: M
authors.lastname: Saman
authors.affiliation: Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA.
authors.forename: David
authors.initials: D
authors.lastname: Stroman
authors.affiliation: Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lee
authors.affiliation: Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA yducic@sbcglobal.net.
authors.forename: Yadranko
authors.initials: Y
authors.lastname: Ducic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064592:Autografts; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D002339:Carotid Arteries / Q000601:surgery*; D005260:Female; D005268:Femoral Vein / Q000637:transplantation; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012501:Saphenous Vein / Q000637:transplantation; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome
keywords: carotid artery sacrifice; head and neck cancer; radical neck dissection; squamous cell carcinoma; unresectable disease