Carotid Artery Surgery for Cervical Lymph Node Invasion: Limitations of Neck Dissection

Objectives/Hypothesis: To evaluate reconstructive surgery of the common carotid artery; and to investigate the indications for this treatment, the limitations of neck dissection as treatment, and the feasibility of concurrent chemoradiation therapy (CCRT). Study Design: Retrospective observational study. Methods: Forty-four patients underwent reconstructive surgery of carotid artery concurrently in radical neck dissection. Twelve patients did not undergo carotid artery reconstruction, 7 underwent reconstruction using a polytetrafluoroethylene (PTFE) graft, 11 underwent reconstruction using an autologous great saphenous vein graft, and 14 underwent vein patch angioplasty after partial resection of the carotid artery. Results: All 7 patients who received PTFE grafts and 11 patients who received saphenous vein grafts died within 2 years after surgery. Four of the 12 patients who did not undergo carotid artery reconstruction and 5 of the 14 patients who underwent vein patch angioplasty survived for 5 years. Conclusion: Patients who underwent neck dissection with reconstructive surgery of the carotid artery had a poor prognosis. Patients who underwent carotid artery resection without reconstruction followed by postoperative radiation therapy survived. CCRT without surgery should be considered in patients with N3 cases.