A case of carotid artery resection and replacement in advanced laryngeal carcinoma

Carotid involvement in head and neck tumours carries a poor prognosis and poses an additional challenge to patient management. Tumor fixity and high-definition imaging modalities can suggest, but not determine, carotid wall invasion, which can be proven only by perioperative observation. Conservative management offers no hope of cure or palliation. While radical tumor excision with carotid peeling or resection seems the only chance for prolonging survival, this strategy has not yet unequivocally improved short-term survival. A 74-year-old man with advanced laryngeal carcinoma presented to our unit with preoperative computed tomographic (CT) signs of neoplastic carotid involvement. Radical surgery was planned and partial hypopharyngectomy, total laryngectomy and left neck dissection were performed. Since grossly indurated tissue extended to the lateral surface of the carotid bifurcation, precluding separation from the vessel, carotid vessel resection and saphenous graft repair were carried out. At 6 months after the operation, the patient is presently alive without neurological complications and free of tumor recurrence or distant metastases. This observation supports the view that CT scanning is a valuable method for detecting malignant carotid invasion and that radical surgery, extending resection to the affected carotid segment, can prolong disease-free short-term survival in this patient group.