1110. High flow Extracranial-Intracranial Bypass for the Treatment of Extensive Recurrent Nasopharyngeal Carcinoma in the Orientals: A Retrospective Review

Authors: Hon Yiu Chiu; Wai Man Lui (Hong Kong, Hong Kong)

Cerebral vascular bypass is an important treatment strategy in skull base tumor and vascular conditions for example aneurysms, Moyamoya disease and radiation therapy-induced pseudoaneurysms. It also forms part of the treatment for extensive head and neck tumors that encases the internal carotid arteries.

Nasopharyngeal carcinoma (NPC) is a common cancer in the orientals. Recurrent NPC however may be managed surgically. Tumor encasement of carotid arteries poses a challenge in resection. Extracranial-intracranial (ECIC) bypass operation allows radical tumor resection with preservation of cerebral blood flow. We would like to provide a retrospective review of the treatment outcomes of ECIC bypass operations performed in conjunction with NPC resections in Queen Mary Hospital, Hong Kong, with a focus on bypass success and patency.

Bypass procedures performed for NPC tumor resection in our hospital between 2002 and 2017 were reviewed. Retrieved data include ischemic symptoms, graft patency and overall survival.

Twenty-three cases of recurrent NPC were treated by ECIC bypass operation and subsequent tumor resection. The median follow-up time was 15 months. Complete patency at 6 months and 3 years were 79% and 33% respectively. Ischemic symptoms were only present in 1 out of the 5 patients who had lost graft patency. The overall 3-year survival was 75%. No bypass-related mortality was reported in this group.

ECIC bypass operation performed for NPC tumor resection in our center showed a reasonable patency rate. 3-year overall survival of our patients with extensive recurrent NPC involving the carotid arteries was comparable to the previously quoted overall survival in recurrent NPC patients who received re-irradiation.

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