Meta-analysis of Outcomes Following Aneurysm Repair in Patients with Synchronous Intra-abdominal Malignancy

Abstract

What this study adds to the existing literature and how it will influence future clinical practice 22The aim of this study was to determine outcomes in patients undergoing abdominal aortic aneurysm 23 (AAA) repair [endovascular (EVAR) or open] who have a synchronous malignancy. Synchronous intra-24 abdominal cancer is relatively common in patients undergoing AAA-repair and surgeons are faced with 25the dilemmas of what type of repair to offer and in what sequence. Our findings support that EVAR is 26 superior regarding short-term mortality. Both EVAR and OAR were associated with significant short-27 term morbidity, which merits careful planning and close follow-up in this patient group. Future studies 28should look into the optimal timing of AAA-repair, for which limited data exist. analysis was applied to assess mortality and major-morbidity at 30-days and long-term. 51 Results:The literature review identified 36 series (543 patients) and the majority (18 series) reported 52 on patients with colorectal-malignancy and AAA. Mean weighted-mortality for OAR at 30-days was 53 11% [95% Confidence Interval (CI): 6.6% to 17.9%]; none of the EVAR patients died peri-operatively. 54The weighted 30-day major complication-rate for EVAR was 20.4% (10.0% to 37.4%) and for OAR it 55 was 15.4% (7.0% to 30.8%). Most patients had their AAA and malignancy treated non-simultaneously 56 (56.6%, 95% CI: 42.1% to 70.1%). In the EVAR cohort 3 patients (4.6%) died at last follow up (range 57 24 to 64 months). In the OAR cohort 23 (10.6%) had died at last follow up (range from 4 to 73 months). 58 Conclusion:In this meta-analysis, OAR was associated with significant peri-operative mortality in 59 patients with an IAM. EVAR should be the first line modality of AAA repair. The majority of patients 60were not treated simultaneously for the two pathologies, but further investigation is necessary to define 61 the optimal timing for each procedure and malignancy. 62

Outcomes after aortic aneurysm repair in patients with history of cancer: a nationwide dataset analysis

“…Many studies have analyzed the effect of AAA repair in patients with synchronous malignancy and showed increased short-term mortality and morbidity after both endovascular aortic repair (EVAR) and open surgical repair (OSR) [3]. In addition, patients with intra-abdominal tumors have increased perioperative mortality after OSR of AAA, and the history of intra-abdominal procedures may hinder OSR due to the development of adhesions [4].…”

Management of Concomitant Abdominal Aortic Aneurysm and Intra-abdominal, Retroperitoneal Malignancy

“…In contrast with this, if the IRM is dealt with in the second stage, and complications arise after the first AAA operation, the interval between operations may be extended incommensurately and there may occur progress with possible generalisation of IRM. These are primarily tumours in higher TNM stage (9). Further possible advantages of an one-stage procedure include resolution of both diseases during a single operation, under general anaesthesia only once.…”

Endovascular Repair for Abdominal Aortic Rupture Caused by Periaortic Mantle Cell Lymphoma

“…8) Furthermore, several studies have reported that EVAR is more advantageous than open repair in patients with synchronous intra-abdominal malignancy. 9) Considering these reports, endovascular repair provides an effective and alternative approach in a situation when conventional open repair may be hazardous or impossible. 10) We also chose EVAR considering the possibility of a tight adhesion between the aorta and lymphoid tissues; consequently, we had a good success.…”