Carotid artery by-pass and head and neck squamous cell carcinoma: Geneva's experience. Should we be afraid of the carotid artery?

To determine the survival, the neurologic morbidity, the post-operative surgical complications, and the predictive factors of patients undergoing a radical neck dissection with carotid by-pass for squamous cell carcinoma of the head and neck (SCCHN).

A retrospective study of 11 patients operated between 1991 and 2007. Besides survival and recurrence, the type of vascular graft, previous radiation, histological carotid invasion, and major complications were evaluated.

The 5-year survival rate was 39%. All deceased patients had a loco-regional recurrence. Salvage surgery and histologic invasion of the carotid artery are negative predictive factors, with an odd-ratio of respectively 6 and 2.5. The rate of neurological morbity is 9% and post-operative complications were found in 18% of patients.

Radical neck dissection with carotid by-pass achieves a good survival rate considering the advanced disease stage of the patients. Autologous venous or arterial graft should be preferred to avoid neurologic complications. Caution should be observed in case of salvage surgery.