Preoperative protective stenting of the carotid artery in severe complex head and neck cancer resection

Objective

To investigate effects of preoperative protective carotid artery (CA) stenting in complex head and neck cancer (HNC) resection.

Material and methods

HNC that encases the CA is complex. Fifty-five patients diagnosed with complex HNC from 2018 to 2021 were enrolled, and were divided into Control group (general complex cases) and carotid artery stent (CAS) group (severe complex cases). All patients underwent standard tumor resection, while patients in the CAS group also underwent preoperative covered CA stenting. Medical information was retrospectively analyzed.

Results

CA stenting and tumor resection were successfully performed. Baseline demographics were recorded. CAS and Control groups had similar results for complete tumor resection rate, operation time, and intraoperative blood loss, although the CA was obviously more involved in CAS group than in Control group. However, recurrence rate in the CAS group was significantly lower than Control group, indicating that preoperative CA stent implantation facilitates complete tumor removal. Furthermore, perioperative CA-associated complications including common/internal CA ligation were more frequent in Control group. Overall survival and disease-free survival rate in CAS group and Control group was 87.5% and 69.2%, respectively. Disease-free survival rate in CAS group and Control group was 87.5% and 42.3%, respectively. No postoperative cerebral infarction was observed in either group. Overall hospitalization cost was recorded.

Conclusions

Preoperative protective CA stenting facilitates more thorough tumor removal while better preserving the CA during complex HNC resection, reducing the surgical difficulty. Preoperative CA stenting may be a safe and effective therapeutic option for resection of HNC encasing the CA.