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May 24-25, 2018
London, UK
Vascular Surgery 2018
3
rd
Edition of World Congress & Exhibition on
Vascular Surgery
Journal of Vascular and Endovascular Therapy
ISSN: 2573-4482
Background:
Involvement of the carotid artery (CA) is
classified as a stage IVb disease, which is considered to be
unresectable. Outcomes of salvage surgery and carotid artery
(CA) management were evaluated in patients with oral and
oropharyngeal cancer.
Patients &Methods:
Thirty-six patients with advanced recurrent
oral and oropharyngeal SCC involving the CA underwent salvage
surgeries and reconstruction with flaps. The age range of the
28 males and eight female patients was 46–72 years. Four
patients suffered carotid blowout requiring emergency surgery.
They underwent wide resection of the tumor with CA resection.
Reconstruction with a vascular prosthesis was performed
in eight (22.2%) patients; eight (22%) others underwent
subadventitial dissection of the CA; four patients (11.1%) were
treated by CA subadventitial dissection and encapsulation
with a vascular prosthesis; and 16 patients (44.4%) underwent
CA resection alone. Reconstruction of the major defect was
performed in 22 patients (61.1%) with an extended vertical
lower trapezius island myocutaneous flap or folded flap; 10
(27.8%) had a pectoralis major myocutaneous flap; two (5.6%)
had a submental flap; and two (5.6%) had a forearm free flap.
Results:
All rCS IVb tumors were completely removed, and
the tissue defects were successfully reconstructed with flaps.
Postoperative transient hemiplegia occurred in two patients
who underwent CA resection, but it resolved completely within
6 weeks. Four patients who underwent CA resection and
reconstruction with a vascular prosthesis or CA subadventitial
dissection suffered carotid blowout during the perioperative
period; both were treated by ligating the CA. Two patients who
underwent CA resection and reconstruction with a vascular
prosthesis had a carotid embolism. None of the patients
developed neurologic sequelae. After 3–46 months of follow-
up, 24 patients (66.7%) had no evidence of disease, four (11.1%)
showed evidence of disease, and eight (22.2%) died of local
recurrence or distant metastases at 5–36 months.
Conclusions:
Although these percentages are far from
optimal, salvage surgery currently offers effective treatment
without major complications for patients with rCS IVb oral
and oropharyngeal SCC involving the CA. CA sacrifice offers a
viable treatment strategy. Major defects can be reconstructed
with a trapezius flap.
Recent Publications
1. Chen W L, Yang Z H, Huang Z Q, et al. (2017)
Craniofacial resection and reconstruction in patients
with recurrent cancer involving the craniomaxillofacial
region. Journal of Oral and Maxillofacial Surgery
75(3):622-631.
2. Chen W L, Yang Z H, Zhou B, et al. (2016) Salvage
surgery for patients with recurrent oral and
oropharyngeal squamous cell carcinoma involving
the carotid artery. Journal of Oral and Maxillofacial
Surgery 74(7):1483-93.
3. Chen W L, Wang Y Y, Zhang D M, et al. (2016) Extended
vertical lower trapezius island myocutaneous flap
versus pectoralis major myocutaneous flap for
reconstruction in recurrent oral and oropharyngeal
cancer. Head Neck. 38(S1):E159-E164.
4. Chen W, Yang Z, Zhang D, et al. (2014) Second salvage
surgery with extended vertical lower trapezius island
myocutaneous flap reconstruction for advanced
re-recurrent oral and oropharyngeal squamous
cell carcinoma. International Journal of Oral and
Maxillofacial Surgery 43(5):531-8
Salvage surgery for patients with recurrent oral and
oropharyngeal squamous cell carcinoma involving the carotid
artery
Wei Liang Chen
Sun Yat-sen University, China
Wei Liang Chen, J Vasc Endovasc Therapy 2018, Volume 3
DOI: 10.21767/2573-4482-C1-002