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Resection and reconstruction of the carotid artery for head and neck squamous cell carcinoma: a GETTEC study

  • Head and Neck
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Abstract

Objectives

Main: To describe 1-year overall survival (OS) after primary or salvage management of head and neck squamous cell carcinoma (HNSCC) invading the common or internal carotid artery (CCA/ICA). Secondary: To assess disease control rate, treatment morbidity, and radio-anatomopathologic correlation.

Methods

Retrospective study of 67 patients, treated between 1999 and 2020 for N3bM0 HNSCC invading the CCA/ICA as identified by CT-scan. Tumors that could not have been resected with a complete en-bloc resection sacrificing and reconstructing the CCA/ICA were excluded. Patients were separated into two groups (primary or salvage treatment) and studied according to the type of treatment they received: radiotherapy/radiochemotherapy (RT/RCT), surgery, or systemic therapy (ST).

Results

For newly treated patients, the 1-year OS was significantly better after RT/RCT (73%) than after surgery (40%, p < 0.0001). In the salvage setting, the 1-year OS after surgery (40%) was better than after ST (14%, statistically suggestive difference with p = 0.0241). Surgery improved cervical control, but distant metastases occurred in more than 50% of cases regardless of treatment. No neurological complication occurred after carotid reconstruction. Perioperative mortality was 7% (1/15). The carotid invasion was confirmed by pathological examination in all five patients with an arterial deformation on CT-scan, in seven among eight patients with CCA/ICA encasement greater than 270°, and in four out of seven patients with CCA/ICA encasement between 180° and 270°.

Conclusion

Neck dissection with carotid resection and reconstruction is technically feasible with acceptable neurovascular morbidity. For newly treated patients, survival is better after RT/RCT. For salvage treatment, surgery could be proposed to selected patients.

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Authors and Affiliations

  1. Surgical Oncology Department, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France

    Yonjae Kim, Lara Nokovitch & Philippe Zrounba

  2. ENT and Head and Neck Surgery Department, Hospices Civils de Lyon, Centre Hospitalier Universitaire de la Croix-Rousse, Lyon, France

    Pierre Philouze & Philippe Céruse

  3. Department of Otorhinolaryngology, CHU Hôtel Dieu, Nantes, France

    Olivier Malard

  4. Department of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalo-Universitaire, Poitiers, France

    Xavier Dufour

  5. Department of Otorhinolaryngology-Head and Neck Surgery, Rouen University Hospital, 37 boulevard Gambetta, 76000, Rouen, France

    Charles Maquet & Sophie Deneuve

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  1. Yonjae Kim
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Correspondence to Sophie Deneuve.

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Kim, Y., Philouze, P., Malard, O. et al. Resection and reconstruction of the carotid artery for head and neck squamous cell carcinoma: a GETTEC study. Eur Arch Otorhinolaryngol 279, 4515–4523 (2022). https://doi.org/10.1007/s00405-022-07342-6

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  • DOI: https://doi.org/10.1007/s00405-022-07342-6

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