Carotid Ligation Vs Carotid Reconstruction in Advanced Head and Neck Carcinomas- A Systematic Review.

Background: Advanced head and neck cancers with carotid artery involvement pose significant therapeutic challenges. While carotid resection and reconstruction are potential management options, the comparative outcomes in terms of survival, mortality, and complications remain unclear.

Objective: To compare the survival outcomes, perioperative mortality, and neurovascular complications in patients undergoing carotid resection versus carotid reconstruction.

Methods: A systematic review of 12 studies involving 215 patients was conducted. Of these, 45 patients underwent carotid resection, and 170 patients underwent carotid reconstruction. Data on survival rates, mortality, complications, and follow-up duration were analyzed.

Results: Carotid reconstruction was associated with significantly higher survival rates (40.59% vs. 6.67%, p < 0.001) and lower mortality (57.64% vs. 88.89%, p < 0.001) compared to resection. Perioperative deaths were significantly lower in the reconstruction group (0.59% vs. 15.56%, p < 0.001). Neurovascular complications were also more frequent in the resection group (33.33% vs. 4.11%, p < 0.001).

Conclusion: Carotid reconstruction is associated with better survival and lower morbidity compared to carotid resection. These findings suggest that carotid reconstruction should be the preferred surgical approach in resectable cases of head and neck cancer with carotid involvement.