Treatment of abdominal aortic aneurysm associated with colorectal cancer: presentation of 14 cases and literature review

Abstract

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.

Management of concurrent colorectal cancer and vascular disease in the endovascular era

“…The magnitude of the operation is increased, however. Veraldi et al reported lower morbidity and mortality in patients with CRC and AAA treated in one stage versus two stages (8 and 4.5% vs. 21.3 and 6%, respectively) [8]. Endovascular therapy appears suitable for a single-stage procedure.…”

Surgery for rare aneurysm associated with colorectal cance

“…The concomitant occurrence of aortic aneurysm and CRC appears to be increasing, from 0.5% to 2% [2] , as a result of the increase in the two individual diseases, which is caused by increased life expectancy and improved imaging capability in revealing additional asymptomatic disease [5] . Published studies are either small case series or limited retrospective reports [3,6] , therefore, the ideal treatment strategy represents a therapeutic dilemma [2] .…”

“…Veraldi et al [5] have found, from Medline 1987-2005, a total of 229 cases of associated aortic aneurysm and CRC. Four emergency operations have been reported, one for rupture of the aortic aneurysm, two for unstable aneurysm, and one for diastatic rupture of the cecum by the stenosing neoplasm in the sigmoid colon.…”

“…In the remaining case, because of postoperative death, only the aneurysm was treated. From January 1988 to May 2006, 14 patients with both diseases were observed and treated in the University of Verona [5] . In one of these patients, only CRC was treated because of poor cardiac conditions, and the patient died after 2 mo from myocardial infarction.…”

“…Such cases include the presence of an abdominal aorta aneurysm with a dangerously large diameter and synchronous obstructing or perforating CRC. Veraldi et al [5] have indicated that a one-stage procedure reduces the length of stay, avoids further surgical and anesthetic trauma, and does not increase graft infection.…”