Sacrifice and extracranial reconstruction of the common or internal carotid artery in advanced head and neck carcinoma: Review and meta-analysis

Head Neck. 2018 Jun;40(6):1305-1320. doi: 10.1002/hed.25093. Epub 2018 Feb 5.


Background: Sacrifice and reconstruction of the carotid artery in cases of head and neck carcinoma with invasion of the common or internal carotid artery is debated.

Methods: We conducted a systematic search of electronic databases and provide a review and meta-analysis.

Results: Of the 72 articles identified, 24 met the inclusion criteria resulting in the inclusion of 357 patients. The overall perioperative 30-day mortality was 3.6% (13/357). Permanent cerebrovascular complications occurred in 3.6% (13/357). Carotid blowout episodes were encountered in 1.4% (5/357). The meta-regression analysis showed a significant difference in 1-year overall survival between reports published from 1981-1999 (37.0%) and 2001-2016 (65.4%; P = .02).

Conclusion: This review provides evidence that sacrifice with extracranial reconstruction of common or internal carotid artery in selected patients with head and neck carcinoma may improve survival with acceptable complication rates. However, all of the published literature is retrospective involving selected series and, therefore, precludes determining the absolute effectiveness of the surgery.

Keywords: carotid artery; complications; head and neck cancer; reconstruction; survival.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carotid Artery, Common / pathology
  • Carotid Artery, Common / surgery*
  • Carotid Artery, Internal / pathology
  • Carotid Artery, Internal / surgery*
  • Disease-Free Survival
  • Female
  • Head and Neck Neoplasms / mortality
  • Head and Neck Neoplasms / pathology*
  • Head and Neck Neoplasms / surgery
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Invasiveness / pathology
  • Neoplasm Metastasis
  • Neoplasm Staging
  • Plastic Surgery Procedures / methods*
  • Prognosis
  • Risk Assessment
  • Survival Analysis