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Oncologic surgical resection with intravascular covered stent placement in patients with carotid artery encased by metastatic cancer---Our experience with 5 patients
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  • Kai Liu,
  • Haidong Zhang,
  • Huanyu Jiang,
  • Shanchun Gong,
  • Xianjun Lyu,
  • Zhenkun Yu
Kai Liu
Southeast University
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Haidong Zhang
The Affiliated BenQ Hospital of Nanjing Medical University
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Huanyu Jiang
Southeast University
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Shanchun Gong
The Affiliated BenQ Hospital of Nanjing Medical University
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Xianjun Lyu
The Affiliated BenQ Hospital of Nanjing Medical University
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Zhenkun Yu
Southeast University
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Abstract

Importance: Tumor encasement of the common carotid artery (CCA) and/or the internal carotid artery (ICA) in patients with advanced head and neck tumors represents a significant surgical challenge. At present, there are few reports on the treatment approach that can achieve the maximal oncological resection and reduce the difficulty of operation without affecting the carotid artery blood flow. Objective: To examine whether the combination of oncologic complete tumor resection and intravascular covered stent placement is more advantageous in the management of advanced head and neck cancer. Design, Setting, and Participants: Five patients with advanced head and neck squamous cell carcinoma (AHNSCC) invading one side of the carotid artery were retrospectively enrolled. The contrast-enhanced computed Tomography (CT) and angiography were performed to assess the severity of extrinsic tumor compression to the carotid artery. Covered stent was placed intra-arterially at least 1 cm proximal and distal beyond the area of tumor involvement. The tumor and the involved carotid artery were resected, and pectoralis major flap transfer was utilized for coverage of the great vessels supported with intra-arterial covered stent. Main Outcomes and Measures: Efficacy of oncologic complete tumor resection combined with endovascular stent placement. Results: The post-stenting demonstrated an improvement in the appearance and caliber of the affected carotid artery. Four patients experienced transient bradycardia and hypotension. All five patients underwent R0 resection. Postoperatively, the flap all had rich vascularity and healing. Three patients underwent adjuvant radiotherapy or chemoradiation. With median follow-up 6.5 months, one patient died of multiple organ failures at 6.5 months after surgery; one patient developed tracheal stoma recurrence and treated with salvaged surgery; the three other patients had no disease recurrence in their last follow-ups. Conclusions and Relevance: Surgical resection with intravascular covered stent placement could potentially achieve the maximal oncological resection without compromise carotid artery blood flow in patients with carotid artery encased head and neck cancer.

Peer review status:UNDER REVIEW

01 Apr 2021Submitted to Clinical Otolaryngology
08 Apr 2021Assigned to Editor
08 Apr 2021Submission Checks Completed
15 Apr 2021Reviewer(s) Assigned