title: Concomitant colorectal cancer and abdominal aortic aneurysm: evolution of treatment paradigm in the endovascular era.
abstract: BACKGROUND
  Although the incidence of patients presenting with concomitant colorectal cancer (CRC) and abdominal aortic aneurysm (AAA) is low, current treatment strategies in patients with both lesions remains controversial. Given recent advances in endovascular aortic aneurysm repair (EVAR), we sought to analyze the surgical outcomes of patients with concomitant CRC and AAA.
  
  
  METHODS
  A retrospective chart review was performed on all patients with CRC and AAA between December 1984 and July 2007.
  
  
  RESULTS
  A total of 108 patients with concomitant CRC and AAA were identified. Forty-six patients presented with symptomatic or obstructing CRC, which was treated with colectomy followed by either open AAA repair (n=35, group A) or EVAR (n=11, group B). Thirty-eight patients underwent either open AAA (n=26, group C) or EVAR (n=12, group D) first, followed by staged CRC resection. Eight patients underwent combined CRC and open AAA repair (group E). The time delays after CRC resection to AAA repair in groups A and B were 42 and 35 days (NS), respectively. The time delays after open AAA or EVAR procedures before CRC resection in groups C and D were 115 days and 12 days (p < 0.0001), respectively. Two patients in group B developed sigmoid ischemia after EVAR and were treated with sigmoid resection. Increased perioperative morbidity and mortality rates were noted in group C (p < 0.002).
  
  
  CONCLUSIONS
  In patients with concomitant colorectal cancer and AAA, the symptomatic lesion should be a treatment priority. Because EVAR results in early recovery and a shorter convalescence compared with open aneurysmorrhaphy, this modality offers potential treatment benefits in patients with suitable anatomy who have concomitant CRC. But EVAR treatment should be offered with caution because of the risk of sigmoid ischemia caused by inferior mesenteric artery occlusion.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Michael E DeBakey VA Medical Center, Houston, TX 77030, USA.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Lin
authors.forename: Neal R
authors.initials: NR
authors.lastname: Barshes
authors.forename: Daniel
authors.initials: D
authors.lastname: Albo
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kougias
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
authors.forename: Tam T
authors.initials: TT
authors.lastname: Huynh
authors.forename: Scott A
authors.initials: SA
authors.lastname: LeMaire
authors.forename: Alan
authors.initials: A
authors.lastname: Dardik
authors.forename: W Anthony
authors.initials: WA
authors.lastname: Lee
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Coselli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D015179:Colorectal Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome