Concomitant Colorectal Cancer and Abdominal Aortic Aneurysm: Evolution of Treatment Paradigm in the Endovascular Era
| Autor: | W. Anthony Lee, Scott A. LeMaire, Alan Dardik, Peter H. Lin, David H. Berger, Daniel Albo, Panagiotis Kougias, Joseph S. Coselli, Tam T. Huynh, Neal R. Barshes |
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| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty Colorectal cancer medicine.medical_treatment Inferior mesenteric artery Blood Vessel Prosthesis Implantation Aortic aneurysm medicine.artery Humans Medicine cardiovascular diseases Aged Retrospective Studies Colectomy Aged 80 and over business.industry Angioplasty Abdominal aorta Cancer medicine.disease digestive system diseases Abdominal aortic aneurysm Surgery Treatment Outcome Concomitant Practice Guidelines as Topic cardiovascular system Female Radiology Colorectal Neoplasms business Aortic Aneurysm Abdominal |
| Zdroj: | Journal of the American College of Surgeons. 206:1065-1073 |
| ISSN: | 1072-7515 |
| Popis: | 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.A retrospective chart review was performed on all patients with CRC and AAA between December 1984 and July 2007.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 (p0.0001), 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 (p0.002).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. |
| Databáze: | OpenAIRE |
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