The carotid artery (common and/or internal) is invaded in 5–10% of cervical lymph node metastasis of head and neck carcinomas. En bloc resection allows a better regional control of the disease and the five-year disease-free survival rate is almost 22% (Pons et al., 2009).

Tumor involving the carotid artery is considered stage IVB disease with a grave prognosis (Kroeker and O'Brien, 2011). Carotid artery resection for head and neck cancer is rare and serious complications may arise, since such cancer is frequently detected in advanced stages (Luna-Ortiz et al., 2023). Although it is uncommon to consider resection of the common and internal carotid artery invaded by carcinoma, nevertheless, if this is the only significant finding precluding an adequate ablative procedure, this operation is worthy of consideration (Loré and Boulos, 1981).

Generally, head and neck carcinomas have an aggressive natural history and the involvement of the carotid artery is considered to be associated with a dismal prognosis. Literature has shown that surgical management is the treatment modality that can achieve optimal outcomes pertaining to the survival in this group of patients, compared to the conservative or palliative treatments. Carotid involvement represents a surgical challenge, on account of the fact that the scenario frequently warrants reconstruction after en bloc tumor and vessel resection. Furthermore, the surgical management of the recurrent or local metastatic carcinoma is more challenging, owing to the presence of scar tissue, while the need to approach the distal internal carotid artery (ICA) adds complexity to an extremely demanding surgical intervention. Nevertheless, the fact that en bloc resection and arterial reconstruction represent the most radical and effective treatment option regarding the management of carcinoma patients with carotid involvement remains unchanged. The aforementioned treatment option prevents the local progression of the disease and results in longer survival periods, regardless of the challenges presented by the same (Kontopodis et al., 2020).

It is also worth mentioning that although carotid artery resection and reconstruction are required for disease control, perioperative and postoperative complications such as cerebrovascular ischemia or graft thrombosis, respectively, may arise and should be assessed along with the ultimate benefit for these individuals. Resection and revascularization of the carotid artery can provide adequate local disease control. However, this surgical procedure seems to have no significant impact on distal metastatic disease, which can occur even in absence of local recurrence.

The purpose of this study is to review the surgical approach and evaluate the results of adult patients with advanced head and neck malignancies, involving the internal carotid artery, treated in the Greek Anticancer Institute, a tertiary referral centre. Taking into consideration the postoperative complications along with the local and distal disease recurrence, the present study is aiming to demonstrate that the surgical resection and reconstruction of the carotid artery yields a chance for cure or provide reasonable palliation, as it can not only improve the quality of life but also prolong the disease-free survival and the overall survival of these individuals.