Management of neck metastasis with carotid artery involvement

To demonstrate aggressive management of neck metastasis adherent to the internal or common carotid artery using sound oncologic principles while minimizing the significant risk of complications.

Our 13 year experience of treating patients with recurrent or residual neck metastasis adherent to the internal or common carotid artery was retrospectively reviewed.

Angiography was used in patients who demonstrated fixation of the carotid artery on examination or imaging, followed by balloon test occlusion and single photon emission computer tomography (SPECT) scanning. The majority of carotid resections were reconstructed with a vein graft, especially if there was insufficient collateral cerebral circulation. Radical resection of the soft tissue including the carotid artery was performed followed by 15 to 20 Gray of electron beam delivered directly to the deep tissue. More recently, the carotid has been permanently occluded preoperatively, if possible. The assessment of the cerebral circulation and management of the carotid artery were analyzed as was survival, site of recurrence, and complications.

Fifty-eight charts were reviewed. The majority of patients (41) had their carotid artery reconstructed at time of resection, and the remaining had either the artery ligated or permanently occluded preoperatively. Strokes occurred in 11 patients. The median disease-specific survival was 12 months, with 24% of patients dying from distant metastasis.

The high risk of complications, loss of life's quality, and mortality must be balanced against the natural history of the disease if left untreated. The decision is a heavy burden for the patient, family, and head and neck surgeon.