Objective: To assess the outcome of aggressive surgical management in patients with advanced head and neck cancer involving the carotid artery.

Patients and Methods: 22 patients were treated between 2006 and 2012 for overt or suspected involvement of common or internal carotid artery with metastatic head and neck cancer. Patient demographics, disease and treatment related factors were extracted from the charts retrospectively. 4 patients were treated with carotid artery resection with reconstruction using the greater saphenous vein. Recurrence and disease specific survival outcomes were compared between different groups.

Results: Median age at diagnosis was 66 years (range 31- 84). Majority of the patients were male (77%), were smokers (82 %) and had recurrent regional metastatic disease at the time of presentation (60%). 18 patients were treated primarily with surgery while the remaining 4 were treated with chemo-radiation as the primary treatment modality. Intra-operatively, 9 out of the 18 patients who were treated with surgery had gross malignant invasion of the carotid artery, with 9 demonstrating involvement without invasion that was able to be removed completely. 4 of 9 patients with gross invasion of the carotid were treated with resection and reconstruction with the saphenous vein, while the remaining 5 patients did not have resection of the carotid. There were no major neurological complications except for 1 patient who had a post- operative stroke.
Out of the 4 patients who were treated with carotid resection, 2 died with a median survival of 3.25 months while 1 is alive with recurrence and 1 with no evidence of recurrence. In the group with unresectable carotid disease, 4 patients died with median survival of 7.15 months and 1 is alive with recurrence.
Out of the 9 patients who had complete surgical removal of tumor, 6 died with median survival of 6 months while 1 is alive with disease and 2 without disease. Out of the 4 patients who received primary chemo-radiation therapy, 2 died with median survival of 18.6 months while 2 are alive with no evidence of recurrence.
This study included both primary and recurrent head and neck cancer. Overall, patients who had a recurrent neck disease had a worse outcome (median survival =3.9 months) compared to those whose neck disease was part of their initial presentation (median survival = 10.2 months).
Overall, 58 % of patients had local recurrence in the neck and 41 % had evidence of distant metastasis during the course of follow up after initiation of treatment for neck disease involving the carotid artery.

Conclusion: Patients with advanced head and neck cancer involving the carotid artery represent an unfortunate group with an inherent dismal prognosis. If the involvement of carotid is part of a recurrent regional metastasis, then the outcome is guarded. When disease burden merits, surgical resection and reconstruction of the carotid artery may be completed without significantly compromising overall survival.