[Salvage surgery for patients with metastatic squamous cell carcinoma involving carotid artery in head and neck].

OBJECTIVE: To study the surgical approaches for metastatic squamous carcinoma involving carotid artery in head and neck.

METHODS: Fifty-seven patients with metastatic squamous carcinoma involving carotid artery were analyzed retrospectively. Forty-eight were undergone peel-off tumor from carotid artery and another 9 with carotid artery resection due to being invaded in the middle layer of the carotid artery wall. None of them were received artery reconstruction. Postoperative radiotherapy was given to those who had radiation with the total dose less than 70 Gy or no radiotherapy, or gross tumor residue during operation.

RESULTS: Of all the 57 patients, 53 had been death and only four survived without clinical lesion. One patient died of postoperative multi-organ failure, 10 of local recurrence, 19 of regional recurrence, 14 of distance metastases, 7 of carotid artery bleeding eroded by tumor, and the remaining 2 of unknown causes. Median survival was 13 months and 1, 2, 3, 5-year overall survival rate was 44.6%, 16.2%, 12.5%, 8.3% respectively, as estimated by the Kaplan-Meier approach. The recurrent rate of gross negative and positive were 26.7% and 50.0% respectively. 2-year survival rate of those were 22.2% and 0 respectively. Recurrent rate and 2-year overall survival rate in patients with and without postoperative radiotherapy was 46.4% and 21.4%, 73.1% and 15.4% respectively.

CONCLUSIONS: It is necessary to perform aggressive salvage operation for patients with metastatic squamous cell carcinoma involving carotid artery. En blok removal of the tumor and the reasonable safe margin should be achieved. Unless the middle layer of the artery wall is involved, tumor peel-off is preferred to carotid resection to reduce the mortality and cerebrovascular complication. Postoperative radiotherapy reduces the recurrent rate and improves overall survival rate potentially.