Urgent carotid artery ligation in advancedhead and neck cancer bleeding

Abstract

Objective: Although bleeding due to head and neck cancer infiltration is a rare complication, it may be life threatening and requires urgent intervention. The aim of this study was to investigate the efficiency of carotid artery ligation applications on bleeding patients with advanced head and neck cancer. Methods: Urgent carotid artery ligation performed in the last 8 years for abundant bleeding in 12 patients with advanced stage head and neck cancer were analyzed retrospectively. The patients were evaluated in terms of demographic characteristics, diagnoses, treatment approaches, neurological complications and mortality. Results: Mean age of 12 patients included in the study was 49.7±9.4 (range 37-69), two of them were females (16.7%) and 10 were males (83.3%). Ten patients were diagnosed as carcinoma of larynx or hypopharynx, whereas one patient had nasal malign melanoma and one patient had buccal carsinoma. Abundant bleeding was observed in patients with recurrent disease after surgery and radiotherapy (n=7), applied radiotherapy or chemoradiotherapy as considered inoperable (n=2), received no treatment (n=2) and patient with recurrence after surgery (n=1). Common carotid artery ligation was performed in 10 patients and external carotid artery ligation was performed in two patients and hemostasis was achieved in all of them. No neurological complications or postoperative mortality were observed in any patients after ligation. Conclusion: In our study, it was observed that application of urgent carotid artery ligation was successful in patients with bleeding due to advanced head and neck surgery. Therefore, it was concluded that carotid artery ligation was a safe and effective method for bleeding due to tumor infiltration.

Keywords

• Head and neck cancer, carotid artery ligation, hemorrhage, bleeding, complication

İleri evre baş boyun kanserleri kanamalarında acil karotid arter ligasyonu

Öz

Amaç: Baş boyun kanserli hastalarda tümör infiltrasyonuna bağlı kanama hayatı tehdit edecek boyutta olabilirse de, nadir rastlanan bir komplikasyondur ve acil girişim gerektirir. Bu çalışmada, kliniğimizde ileri evre baş boyun kanserli hastalarda görülen hayatı tehdit eden kanamalarda acil olarak yapılan karotid arter ligasyonu uygulamaları retrospektif olarak incelendi. Yöntem: İleri evre baş boyun kanserli hastalarda gelişen hayatı tehdit eden kanama nedeniyle son sekiz yılda acil şartlarda karotid arter ligasyonu yapılan 12 hasta retrospektif olarak incelendi. Hastalar demografik özellikler, tanılar, tedavi yaklaşımları, ligasyon sonrası gelişen nörolojik komplikasyonlar ve mortalite açısından değerlendirildi. Bulgular: Çalışmaya alınan 12 hastanın (2 kadın 10 erkek) yaş ortalaması 49.7±9.4 (alt-üst sınır 37-69) yıl idi. On hasta larenks veya hipofarenks karsinomu, bir hasta nazal malign melanom ve bir hasta da bukkal karsinom tanısı ile izlenmekte idi. Kanama, cerrahi ve radyoterapi sonrası nüks gelişen (n=7), inoperabl olarak değerlendirilip radyoterapi veya kemoradyoterapi uygulanan (n=2), hiç tedavi almayan (n=2) ve cerrahi sonrası nüks olan (n=1) hastalarda görüldü. Tedavi amacı ile 10 hastaya (%83.3) a. karotis kommunis, ikisine (%16.7) a. karotis eksterna ligasyonu yapıldı ve tümünde kanama kontrolü sağlandı. Cerrahi sonrası nörolojik komplikasyon veya mortalite hiçbir hastada gözlenmedi. Sonuç: Çalışmamızda ileri evre baş boyun kanserli hastalarda görülen hayatı tehdit eden kanamalarda acil olarak yapılan karotid arter ligasyonu uygulamalarının başarılı olduğu gözlendi. Sonuç olarak, tümör infiltrasyonuna bağlı kanamalarda karotid arter ligasyonunun güvenli ve etkili bir yöntem olduğu sonucuna varıldı.

Anahtar Kelimeler

• Baş boyun kanseri, karotid arter ligasyonu, hemoraji, komplikasyon

Kaynakça

1. 1. Wurm J, Gode U, Fucak A. Ligature of the carotid arteries performed prophylactically or as an emergency procedure in patients with malignant tumours of the head and neck. HNO 2000;48:22-7.
2. 2. Koopmann CF, Coulthard SW, Malone JM, et al. Complications of carotid artery replacement in head and neck neoplasms. Otolaryngol Head Neck Surg 1982;90:561-6.
3. 3. Prokofev VE, Lebedev SN. Role of ligation of the external carotid artery in the treatment of malignant tumors of the tongue. Stomatologiia (Mosk) 2004;83:36-8.
4. 4. Sesterhenn AM, Iwinska-Zelder J, Dalchow CV, et al. Acute haemorrhage in patients with advanced head and neck cancer: value of endovasculartherapy as palliative treatment option. J Laryngol Otol 2006;120:117-24.
5. 5. Low YM, Goh YH. Intra-arterial embolisation in otolaryngology - a four-year review. Singapore Med J 2003;44:35-8.
6. 6. Luo CB, Chang FC, Teng MM, et al. Endovascular treatment of the carotid artery rupture with massive hemorrhage. J Chin Med Assoc 2003;66:140-7.
7. 7. Guerrissi JO, Yoel J. External carotid ligature: posterior approach (behind the sternocleidomastoid muscle). Int Surg 1977;62:601-2.
8. 8. Roski RA, Spetzler RF, Nulsen FE. Late complications of carotid ligation in the treatment of intracranial aneurysms. Neurosurg 1981;54:583-7.

9. 9. Winn HR, Richardson AE, Jane JA. Late morbidity and mortality of common carotid ligation for posterior communicating aneurysms. A comparison to conservative treatment. J Neurosurg 1977;47:727-36