Concomitant Colorectal Cancer and Abdominal Aortic Aneurysm: Evolution of Treatment Paradigm in the Endovascular Era

Peter H. Lin, Neal R. Barshes, Daniel Albo, Panagiotis Kougias, David H. Berger, Tam T. Huynh, Scott A. LeMaire, Alan Dardik, W. Anthony Lee, Joseph S. Coselli

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: 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. Study Design: A retrospective chart review was performed on all patients with CRC and AAA between December 1984 and July 2007. Results: 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 (p < 0.0001), 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 (p < 0.002). Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)1065-1073
Number of pages9
JournalJournal of the American College of Surgeons
Volume206
Issue number5
DOIs
StatePublished - May 1 2008

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Abdominal Aortic Aneurysm
Colorectal Neoplasms
Aortic Aneurysm
Sigmoid Colon
Therapeutics
Ischemia
Inferior Mesenteric Artery
Colectomy
Anatomy
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Concomitant Colorectal Cancer and Abdominal Aortic Aneurysm : Evolution of Treatment Paradigm in the Endovascular Era. / Lin, Peter H.; Barshes, Neal R.; Albo, Daniel; Kougias, Panagiotis; Berger, David H.; Huynh, Tam T.; LeMaire, Scott A.; Dardik, Alan; Lee, W. Anthony; Coselli, Joseph S.

In: Journal of the American College of Surgeons, Vol. 206, No. 5, 01.05.2008, p. 1065-1073.

Research output: Contribution to journalArticle

Lin, PH, Barshes, NR, Albo, D, Kougias, P, Berger, DH, Huynh, TT, LeMaire, SA, Dardik, A, Lee, WA & Coselli, JS 2008, 'Concomitant Colorectal Cancer and Abdominal Aortic Aneurysm: Evolution of Treatment Paradigm in the Endovascular Era', Journal of the American College of Surgeons, vol. 206, no. 5, pp. 1065-1073. https://doi.org/10.1016/j.jamcollsurg.2007.12.011
Lin, Peter H. ; Barshes, Neal R. ; Albo, Daniel ; Kougias, Panagiotis ; Berger, David H. ; Huynh, Tam T. ; LeMaire, Scott A. ; Dardik, Alan ; Lee, W. Anthony ; Coselli, Joseph S. / Concomitant Colorectal Cancer and Abdominal Aortic Aneurysm : Evolution of Treatment Paradigm in the Endovascular Era. In: Journal of the American College of Surgeons. 2008 ; Vol. 206, No. 5. pp. 1065-1073.
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AU - Albo, Daniel

AU - Kougias, Panagiotis

AU - Berger, David H.

AU - Huynh, Tam T.

AU - LeMaire, Scott A.

AU - Dardik, Alan

AU - Lee, W. Anthony

AU - Coselli, Joseph S.

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AB - Background: 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. Study Design: A retrospective chart review was performed on all patients with CRC and AAA between December 1984 and July 2007. Results: 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 (p < 0.0001), 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 (p < 0.002). Conclusions: 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.

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