Abstract
Purpose
The management of abdominal aortic aneurysm (AAA) with concomitant malignancy is controversial in terms of which treatment should come first. The aim of this study was to evaluate the outcomes of endovascular aortic repair (EVAR) as the initial treatment prior to the treatment of malignancy for patients with AAA and concomitant malignancy.
Methods
EVAR for AAA was performed in 1,175 cases between April 2007 and April 2014, of which 63 patients (5.4 %) who had AAAs and malignancy were identified. The clinical details and outcomes for patients with AAA and malignancy were evaluated.
Results
The mean age of patients with AAA and malignancy was 76.6 years. Thirty-three patients underwent EVAR before surgery for their malignancies, and 30 patients received chemoradiotherapy following EVAR. No significant differences in the length of stay (LOS), 30-day mortality, and morbidities were observed in all groups. However, the overall survival rate of the patients who had AAA and malignancy was lower than those who had only AAA (P < 0.0001). The mean intervals from EVAR to surgery and chemoradiotherapy for malignancy in our institution were 13.4 days (overall 38.1 days) and 5.8 days (overall 18.2 days), respectively.
Conclusion
EVAR for patients with AAA and concomitant malignancy may be acceptable in terms of a short LOS and resulting in treatment for malignancy without delay.
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References
Szilagyi DE, Elliott JP, Berguer R. Coincidental malignancy and abdominal aortic aneurysm. Arch Surg. 1967;95:402–12.
Porcellini M, Nastro P, Bracale U, Brearley S, Giordano P. Endovascular versus open surgical repair of abdominal aortic aneurysm with concomitant malignancy. J Vasc Surg. 2007;46:16–23.
Shalhoub J, Naughton P, Lau N, Tsang JS, Kelly CJ, Leahy AL, et al. Concurrent colorectal malignancy and abdominal aneurysm: a multicentre experience and review of the literature. Eur J Endovasc Surg. 2009;37:544–6.
Matsumoto K, Nakamura M, Obara H, Hayashi S, Harada H, Kitajima M, et al. Surgical strategy for abdominal aortic aneurysm with concurrent symptomatic malignancy. World J Surg. 1999;23:248–51.
Lin PH, Barshes NR, Albo D, Kougias P, Berger DH, Huynh TT, et al. Concomitant colorectal cancer and abdominal aortic aneurysm: evolution of treatment paradigm in endovascular era. J Am Coll Surg. 2008;206:1065–73.
Jabawi A, Ahmed I, El-Sakka K, Yusuf SW. Management of concomitant cancer and abdominal aortic aneurysm. Cadiol Res Pract. 2011;19:516146.
Morris HL, Da Silva AF. Co-existing abdominal aortic aneurysm and intra-abdominal malignancy: reflections on the order of treatment. Br J Surg. 1998;85:1185–90.
Lobbato VJ, Rorthenberg RE, LaRaja RD, Georgiou J. Coexsistence of abdominal aortic aneurysm and carcinoma of the colon: a dilemma. J Vasc Surg. 1985;2:724–6.
Nora JD, Pairolero PC, Nivatvongs S, Cherry KJ, Hallet JW, Gloviczki P. Concomitant abdominal aortic aneurysm and colorectal carcinoma: priority of resection. J Vasc Surg. 1989;9:630–6.
Shimada Y, Sogawa M, Okada A. A single-staged operation for abdominal aortic aneurysm with concomitant colorectal carcinoma. Ann Thorac Cardiovasc Surg. 2005;11:339–42.
Kurata S, Nawata K, Nawata S, Namura O, Hayashi J, Iiai T, et al. Surgery for abdominal aortic aneurysm associated with malignancy. Surg Today. 1998;28:895–9.
Komori K, Okadome K, Odashiro T, Ishii T, Itoh H, Funahashi S, et al. Simultaneous resection of abdominal aortic aneurysms and early gastric cancer by retroperitoneal and transperitoneal approach. Eur J Vasc. 1992;6:639–41.
Hafez KS, Fettouh EL, Novick AC, Ouriel K. Management of synchronous renal neoplasm and abdominal aortic aneurysm. J Vasc Surg. 2000;12:1102–10.
Verardi GF, Tasselli S, De Manzoni G, Cordiano C. Surgical treatment of abdominal aortic aneurysm with concomitant renal cell carcinoma: a single- centre experience with review of literature. J Cardiovasc Surg (Torino). 2006;53:973–5.
Borzellino G, Giovinazzo F, Minicozzi AM, Dusui R, Politi L, Veraldi GF. Concomitant pulmonary carcinoma and abdominal aortic aneurysm: therapeutic strategies. Surg Today. 2008;38:512–6.
Blochle R, Lall P, Cherr GS, Harris LM, Dryjski ML, Hsu HK, et al. Management of patients with concomitant lung cancer and abdominal aortic aneurysm. Am J Surg. 2008;196:697–702.
Galt SW, McCarthy WJ, Pearce WH, Carter MF, Dalton DP, Garmett JE, et al. Simultaneous abdominal aortic aneurysm repair and nephrectomy for neoplasm. Am J Surg. 1995;170:227–30.
Swanson RJ, Littooy FN, Hunt TK, Stoney RJ. Laparotomy as a precipitating factor in the rupture of intra-abdominal aneurysm. Arch Surg. 1980;115:299–304.
Baxter NN, Noel AA, Cherry K, Wolff BG. Management of patients with colorectal cancer and concomitant abdominal aortic aneurysm. Dis Colon Rectum. 2002;45:165–70.
Grego F, Lepidi S, Bassi P, Tavolini IM, Noventa F, Pagano F, et al. Simultaneous surgical treatment of abdominal aortic aneurysm and carcinoma of the bladder. J Vasc Surg. 2003;37:607–14.
Robinson G, Hughes W, Lippey E. Abdominal aortic aneurysm and associated colorectal carcinoma: a management problem. Aust N Z J Surg. 1994;64:475–8.
Trueblood HW, Williams DK, Gustafson JR. Aneurysmal rupture following resection of abdominal malignancy. Am Surg. 1976;42:535–7.
Ochsner JL, Cooley DA, De Bakey ME. Associated intra-abdominal lesions encountered during resection of aortic aneurysms. Surgical considerations. Dis colon Rectum. 1960;3:485–90.
EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR 1 trial): randomized controlled trial. Lancet. 2005;365:2179–86.
Gleenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D, Sculpher MJ, United Kingdom EVAR Trial investigators. Endovascular versus open repair of abdominal aortic aneurysm. N Eng J Med. 2010;362:1863–71.
Thomas DM, Hulten EA, Ellis ST, Anderson DM, Anderson N, McRae F, et al. Open versus endovascular repair of abdominal aortic aneurysm in the elective and emergent setting in a pooled population of 37,781 patients: a systematic review and meta-analysis. ISRN Cardiol. 2014;1–9. Article ID 149243. doi:10.1155/2014/149243
Coughlin PA, Jackson D, White AD, Bailey MA, Farrow C, Scott DJA, et al. Meta-analysis of prospective trials determining the short- and mid-term effect of elective open and endovascular repair of abdominal aortic aneurysms on quality of life. Br J Surg. 2013;100:448–55.
Stather PW, Sidoloff D, Dattani N, Choke E, Brown MJ, Sayers RD. Systematic review and meta-analysis of early and late outcomes of open and endovascular repair of abdominal aortic aneurysm. Br J Surg. 2013;100:863–72.
Matsumoto T, Tanaka S, Okadome J, Kyuragi R, Fukunaga R, Kawakubo E, et al. Midterm outcomes of endovascular repair for abdominal aortic aneurysms with the on-label use compared with the off-label use of an endoprosthesis. Surg Today. 2015;45:880–5.
Ishibashi H, Ishiguchi T, Ohta T, Sugimoto I, Iwata H, Yamada T, et al. Late events and mid-term results after endovascular aneurysm repair. Surg Today. 2014;44:50–4.
Lujan J, Valeno G, Hernandez Q, Sanchez A, Frutos MD, Parrilla P. Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg. 2009;96:982–9.
Fleshman J, Srgent DJ, Green E, Anvari M, Stryker SJ, Beart RB Jr, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST study group trial. Ann Surg. 2007;246:655–64.
Tanimura S, Higashino M, Fukunaga Y, Takemura M, Tanaka Y, Fujiwara Y, et al. Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc. 2008;22:1161–4.
Fujiwara M, Kodera Y, Miura S, Kanyama Y, Yokoyama H, Ohashi N, et al. Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a phase II study following the learning curve. J Surg Oncol. 2005;91:26–32.
Palm SJ, Russwurm GP, Chang D, Rozenblit AM, Ohki T, Veith FJ. Acute enlargement and subsequent rupture of an abdominal aortic aneurysm in a patient receiving chemotherapy for pancreatic carcinoma. J Vasc Surg. 2000;32:197–200.
Lauro S, Lanzetta G, Baria E, Trasatti L, Gelibter A, Vecchione A. Antiblastic chemotherapy in the presence of abdominal aorta aneurysm (AAA): guidelines. Anticancer Res. 1999;2B:1439–44.
Mallioux A, Grenet K, Bruneel A, Beneteau-Bumat B, Vaubourdolle M, Baudin B. Anticancer drugs induce necrosis of human endothelial cells involving both oncosis and apoptosis. Eur J Cell Biol. 2001;80:442–9.
Seqelov E, Chan D, Shapiro J, Price TJ, Karapetis CS, Tebbutt NC, et al. The role of biological therapy in metastatic colorectal cancer after first-line treatment; a meta-analysis of randomized trials. Br J Cancer. 2014;6:1122–31.
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Maeda, K., Ohki, T., Kanaoka, Y. et al. Current surgical management of abdominal aortic aneurysm with concomitant malignancy in the endovascular era. Surg Today 46, 985–994 (2016). https://doi.org/10.1007/s00595-015-1262-8
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DOI: https://doi.org/10.1007/s00595-015-1262-8