Concurrent Colorectal Malignancy and Abdominal Aortic Aneurysm: A Multicentre Experience and Review of the Literature

• Published in: European journal of vascular and endovascular surgery 2009-05, Vol.37 (5), p.544-556
• Main Authors: Shalhoub, J, Naughton, P, Lau, N, Tsang, J.S, Kelly, C.J, Leahy, A.L, Cheshire, N.J.W, Darzi, A.W, Ziprin, P
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic aneurysm; Aortic Aneurysm, Abdominal - complications; Aortic Aneurysm, Abdominal - diagnosis; Aortic Aneurysm, Abdominal - surgery; Aortic Rupture - epidemiology; Colectomy - methods; Colorectal cancer; Colorectal Neoplasms - complications; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - surgery; Endovascular aortic repair; Female; Follow-Up Studies; Humans; Intraoperative Complications - epidemiology; Length of Stay; Male; Middle Aged; Morbidity - trends; Neoplasm Staging - methods; Postoperative Complications - epidemiology; Prognosis; Prospective Studies; Surgery; Survival Rate - trends; Tomography, X-Ray Computed; United Kingdom - epidemiology; Vascular Surgical Procedures - methods
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2009.01.004

Summary Objectives There is lack of consensus regarding concurrent vs. staged approaches, and the prioritisation of staged procedures in cases presenting with colorectal carcinoma (CRC) and abdominal aortic aneurysm (AAA) synchronously. We aim to present our experience, review the literature on this therapeutic dilemma and examine the role of endovascular aortic repair (EVAR). Design, materials and methods An observational study of the experience of two centres and a systematic review of the published literature. Results Twenty-four patients were identified from the prospective databases of two tertiary referral centres between 2001 and 2006. Intervention for both malignancy and aneurysm was performed in 13 patients. In 10 patients, cancer resection was performed initially and was followed by open aneurysm repair ( n = 3) or EVAR ( n = 7). Two patients (AAA diameters: 7.0 and 8.0 cm) underwent EVAR prior to colonic resection. One patient was selected for synchronous surgery. There were no interval AAA ruptures, graft infection or postoperative mortalities. Literature review identified 269 such cases; of these 101 were treated by combined surgery. In staged surgery, there were nine interval aneurysmal ruptures and one aortic graft infection. Conclusions In our experience, staged management can be undertaken, without interval aneurysmal rupture. EVAR has an evolving role in preventing delay in CRC management, in high-risk patients, and during combined intervention.