title: Resection of recurrent neck cancer with carotid artery replacement.
abstract: The management of patients with recurrent neck cancer invading the carotid artery is controversial. The purpose of this study was to evaluate overall survival rate, primary patency of vascular reconstructions, and quality-adjusted life-years (QALYs) after en bloc resection of the carotid artery and tumor with in-line polytetrafluoroethylene (PTFE) carotid grafting, followed by radiotherapy.
  
  
  
  From 2000 to 2014, 31 consecutive patients with recurrent neck cancer invading the carotid artery underwent en bloc resection and simultaneous carotid artery reconstruction with a PTFE graft, which was associated in 18 cases with a myocutaneous flap. The primary tumor was a squamous cell carcinoma of the larynx in 17 patients and of the hypopharynx in 7, an undifferentiated carcinoma of unknown origin in 4, and an anaplastic carcinoma of the thyroid in 3. All of the patients underwent postoperative radiotherapy (50-70 Gy), and 10 of them also underwent chemotherapy (doxorubicin and cisplatin).
  
  
  
  None of the patients died or sustained a stroke during the first 30 days after the index procedure. Postoperative morbidity consisted of 6 transitory dysphagias, 3 vocal cord palsies, 2 wound dehiscences, 1 transitory mandibular claudication, and 1 partial myocutaneous flap necrosis. No graft infection occurred during follow-up. Fifteen patients (48%) died from metastatic cancer during a mean follow-up of 45.4 months (range, 8-175 months). None of the patients showed evidence of local recurrence, stroke, or thrombosis of the carotid reconstruction. The 5-year survival rate was 49 ± 10%. The overall number of QALYs was 3.12 (95% confidence interval, 1.87-4.37) with a significant difference between patients without metastasis at the time of redo surgery (n = 26; QALYs, 3.74) and those with metastasis (n = 5; QALYs, 0.56; P = .005). QALYs were also significantly improved in patients with cancer of the larynx (n = 17; QALYs, 4.69) compared to patients presenting with other types of tumors (n = 14; QALYs, 1.29; P = .032).
  
  
  
  Aggressive en bloc resection of recurrent neck cancer with PTFE grafting can be curative in patients without metastases at the time of redo surgery. In this subset of patients, extensive neck surgery with carotid artery replacement can lead to excellent local control of the disease with improved quality of survival.
authors.affiliation: "F. Durante" Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy. Electronic address: giulio.illuminati@uniroma1.it.
authors.forename: Giulio
authors.initials: G
authors.lastname: Illuminati
authors.affiliation: Department of Vascular Surgery, University of Poitiers, Poitiers, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Schneider
authors.affiliation: Department of Otolaryngology, University of Rome "La Sapienza", Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Minni
authors.affiliation: "F. Durante" Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy.
authors.forename: Francesco G
authors.initials: FG
authors.lastname: Calio
authors.affiliation: "F. Durante" Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Pizzardi
authors.affiliation: Department of Vascular Surgery, University of Poitiers, Poitiers, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Ricco
mesh_terms: D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap; D037981:Neck Dissection / Q000009:adverse effects / Q000401:mortality; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene