title: Management of concomitant abdominal aortic aneurysm and colorectal cancer.
abstract: OBJECTIVE
  To conduct a systematic review of the literature and perform an analysis of outcomes of treatment of concomitant colorectal cancer (CRC) and abdominal aortic aneurysm (AAA) with a focus on the different treatment options and the related therapeutic outcomes.
  
  
  METHODS
  A review of the English-language medical literature from 1980 to 2015 was undertaken using the PubMed and EMBASE databases to identify studies reporting surgical treatment of patients with concomitant CRC and AAA. The search identified 24 articles encompassing 254 patients (81% male; mean age 73.5 ± 6.1 years).
  
  
  RESULTS
  In 96 patients (37.9%) cancer resection was performed first, followed by AAA repair at a later stage (open aortic repair [OAR], 79.2%; endovascular abdominal aortic repair [EVAR], 20.8%). Eighty-two patients (32.3%) underwent AAA repair (OAR, 47.5%; EVAR, 52.5%) before CRC resection. Seventy-one patients (27.9%) underwent combined OAR and CRC resection, and just five (1.9%) were treated with EVAR and cancer surgery in a single stage. There were eight of 96 interval AAA ruptures (8.3%), mostly in the early postoperative period concerning aneurysms >6 cm in diameter. The mean interval between the two procedures was much shorter in patients treated with EVAR than OAR (11.5 ± 1.8 days vs 103.9 ± 42.3 days). The overall 30-day mortality rate was 10.9%. Data from observational studies showed no significant differences in 30-day mortality between patients treated in one or two stages (P = .89). No mortality was recorded in any of the EVAR-treated patients. There was only one graft infection recorded (0.4%).
  
  
  CONCLUSIONS
  Among different approaches, no significant differences in 30-day outcomes among patients treated in either two or one stage were evident. EVAR showed the lowest mortality and also diminished the delay between the two procedures in <2 weeks for a two-stage approach, although it has been associated with a significant risk for thrombotic events. The coexistence of AAA and CRC seems to favor the use of EVAR in treating those patients.
authors.affiliation: Vascular Surgery Unit, Department of Surgery, University of Ioannina, Ioannina, Greece.
authors.forename: George N
authors.initials: GN
authors.lastname: Kouvelos
authors.affiliation: Vascular Surgery Unit, First Department of Surgery, Medical School, University of Athens, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Patelis
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, United Kingdom.
authors.forename: George A
authors.initials: GA
authors.lastname: Antoniou
authors.affiliation: Vascular Surgery Unit, Third Department of Surgery, University of Athens, Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Lazaris
authors.affiliation: Department of Surgery, University of Ioannina, Ioannina, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Bali
authors.affiliation: Vascular Surgery Unit, Department of Surgery, University of Ioannina, Ioannina, Greece. Electronic address: mimats@cc.uoi.gr.
authors.forename: Miltiadis
authors.initials: M
authors.lastname: Matsagkas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D003082:Colectomy / Q000009:adverse effects / Q000401:mortality; D015179:Colorectal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome