Treatment of abdominal aortic aneurysm associated with colorectal cancer: presentation of 14 cases and literature review.
OBJECTIVE
The coexistence of abdominal aortic aneurysm (AAA) and cancer is observed with increasing frequency, raising several questions about therapeutic and surgical strategies for management of both diseases. In this study, we present our experience on 14 patients affected by both colorectal cancer (CRC) and AAA, and we have also reviewed the literature from 1988 to 2005 for clinical experiences on this matter.


METHODS
From January 1988 to May 2006, 1,012 AAA and 1,480 CRC were observed and treated in our department; in 14 patients (1.3% of AAA and 0.9% of CRC), both diseases were coexistent. We also performed a literature review from 1987 to 2005, and we found 254 cases of AAA associated with CRC.


RESULTS
Priority was given for treatment of vascular disease. The diseases were treated in one stage in nine cases and in two stage in four patients; in the remaining case, only the CRC was treated due to patient's poor cardiac conditions. Postoperative (30-day) complications were seen in 1 of 14 patients (7.1%), whereas there were no postoperative deaths or prosthetic infections. In the literature review, treatment in one stage was performed in 102 cases and in two stage in 118 cases; in the remaining 25 cases, only one disease was treated (in 24 cases, for different reasons, only CRC was treated, whereas in the last case, only the AAA was treated, and the patient died in the postoperative period). Postoperative (30-day) morbidity and mortality in one-stage treatment were 8 and 4.5%, respectively, and 21.3 and 6% in two-stage treatments, respectively. In patients treated for only one disease, 30-day morbidity and mortality were 4 and 24%, respectively. Only one case of prosthetic infection was reported after a two-stage treatment.


CONCLUSIONS
From the analysis of the literature and our experience, it is evident that, when AAA and CRC are coexistent with preoperative diagnosis of both diseases, single-stage intervention, when feasible for patient in general and local conditions, has to be preferred due to the lower morbidity. Single-stage treatment avoids a second surgical and anesthesiologic trauma and eliminates the risks joined with the non-treated lesion, increasing, however, the magnitude of the operation. Endovascular therapy, for its less invasiveness, appears to be an adequate solution for one-stage treatment of the two diseases but its role is still subject of ongoing discussions.
Veraldi
G F
GF
Università degli Studi di Verona, II Scuola di Specializzazione in Chirurgia Generale, Struttura Semplice Organizzativa di Chirurgia Vascolare, Ospedale Civile Maggiore, Verona, Italy. gianfraco.veraldi@azosp.vr.it
Minicozzi
A M
AM
Leopardi
F
F
Ciprian
V
V
Genco
B
B
Pacca
R
R
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001706:Biopsy; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*