Simultaneous repair of abdominal aortic aneurysm and resection of unexpected, associated abdominal malignancies.
OBJECTIVE
The management of unexpected intra-abdominal malignancy, discovered at laparotomy for elective treatment of an abdominal aortic aneurysm (AAA), is controversial. It is still unclear whether both conditions should be treated simultaneously or a staged approach is to be preferred. To contribute in improving treatment guidelines, we retrospectively reviewed the records of patients undergoing laparotomy for elective AAA repair.


METHODS
From January 1994 to March 2003, 253 patients underwent elective, trans-peritoneal repair of an AAA. In four patients (1.6%), an associated, unexpected neoplasm was detected at abdominal exploration, consisting of one renal, one gastric, one ileal carcinoid, and one ascending colon tumor. All of them were treated at the same operation, after aortic repair and careful isolation of the prosthetic graft.


RESULTS
The whole series' operative mortality was 3.6%. None of the patients simultaneously treated for AAA and tumor resection died in the postoperative period. No graft-related infections were observed. Simultaneous treatment of AAA and tumor did not prolong significantly the mean length of stay in the hospital, compared to standard treatment of AAA alone.


CONCLUSIONS
Except for malignancies of organs requiring major surgical resections, simultaneous AAA repair and resection of an associated, unexpected abdominal neoplasm can be safely performed, in most of the patients, sparing the need for a second procedure. Endovascular grafting of the AAA can be a valuable tool in simplifying simultaneous treatment, or in staging the procedures with a very short delay.
Illuminati
Giulio
G
The "Francesco Durante" Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy. giulio.illuminati@uniroma1.it
Calio'
Francesco G
FG
D'Urso
Antonio
A
Lorusso
Riccardo
R
Ceccanei
Gianluca
G
Vietri
Francesco
F
D000008:Abdominal Neoplasms / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000379:methods; D003082:Colectomy; D003110:Colonic Neoplasms / Q000601:surgery; D017558:Elective Surgical Procedures; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007078:Ileal Neoplasms / Q000601:surgery; D007680:Kidney Neoplasms / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery; D013514:Surgical Procedures, Operative / Q000379:methods*; D016896:Treatment Outcome