Objective:To analyze the
therapeutic effect of internal carotid artery resection and one-stage revascularization in advanced cervical metastatic
carcinoma. Method:Twenty-one patients with advanced head and neck malignant
tumors who underwent internal carotid artery resection and one-stage revascularization were analyzed retrospectively. Among those, 11 patients suffered from hypo-pharyngeal
carcinomas, 5 laryngeal
carcinomas, 2 external auditory
carcinomas, 1 middle ear
carcinoma, and 2 parotid gland
carcinomas. All patients received CT, MRI, DSA and other examinations before operation. It was found that all the internal carotid artery walls had been invaded by
tumors, and there were different degrees of lumen
stenosis. Autogenous saphenous vein grafts were used in 18 cases; artificial vessels were used in 3 cases. After revascularization, pedicled or
free flaps were used to protect the anastomotic areas. All patients were treated with
radiotherapy and
chemotherapy according to different situations. Result:Among the 21 cases, 16 cases underwent reconstruction of cervical segment internal carotid and 5 cases were the skull base segment internal carotid. Twenty patients were successfully reconstructed in the first stage, and no vascular reconstruction-related nervous system complications occurred after operations. Postoperative imaging showed that the reconstructed blood vessels were well recanalized, with a success rate of 95.2%(20/21). Only 1 case received
ligation of internal carotid artery after the failure of vascular reconstruction. Among all the cases, the 1-year survival rate and 3-year survival rate were 90.5% and 40.4%, respectively. Conclusion:In patients with advanced head and neck malignant
tumors with cervical metastatic
cancer invading the internal carotid artery, one-stage revascularization after radical resection of the
tumor and the internal carotid can achieve good
therapeutic effect. Careful preoperative evaluation, proficient vascular anastomosis technology, adequate risk assessment and prevention are the key to the success of the operations.