Advanced cervical metastasis involving the carotid artery

This paper will review recent reports of the surgical management of the carotid artery when cancer is adherent to it and will highlight the author's experience at Clarian Health Partners in Indianapolis.

Recent trends in treating metastatic neck cancer with chemoradiation initially and reserving surgery for the treatment of residual or recurrent disease has tasked the head and neck surgeon with extirpating cancer in significantly altered tissue with loss of tissue planes and scarring that conceals the extent of cancer spread. Cancer that is adherent to the carotid presents a treatment dilemma to the surgeon, given that historically the local control and survival has been dismal and the complications of surgery are high.

The heavy burden of deciding to resect the carotid artery involved with recurrent or residual cancer should be balanced against the natural history of the disease process if not it is treated. It requires detailed understanding by the patient and family as well as coordination among the interventional radiologist, anesthesiologist, radiation oncologist, intensivist, and head and neck surgeon.