Synchronous Repair for Abdominal Aortic Aneurysms and Intra-abdominal Malignant Disease

Aim. Controversy surrounds the best surgical treatment of simultaneous intra-abdominal aortic and neoplastic disease in order to establish which disease should have the priority. The theoretical increased risk of graft infection, despite little evidence in literature, remains the main argument against synchronous surgery. Methods. During the last 15-years we performed 512 aortic repairs for abdominal aneurysm. We observed 20 (3%) patients affected by abdominal aortic aneurysms and concomitant abdominal tumours: 9 (45%) renal cell carcinomas, 8 (40%) tumours of the urinary bladder, 1 gastric cancer, 1 adrenal carcinoma and 1 uterine carcinoma. Sixteen patients (80%) had both disease occasionally detected during preoperative staging. Sixteen patients underwent single stage resection of the aneurysm and the tumour. Four (20%) of them had emergency repair for a ruptured aneurysm. Results. Median size was 58 mm. Mean blood loss was 567 mL. Two patients in the elective group (13%) and 2 in the emergency one (40%), required ICU stay because of severe cardiorespiratory failure. Two patients died for multiple organ failure. Major postoperative complications occurred in 5 patients: acute renal failure was the most common one (15%). There was no evidence of graft infection. Median length of stay was 14 days. Mean and median actuarial survival rates were 43-months and 54-months, respectively Conclusion. We believe that simultaneous surgical approach to co-existing diseases may represent a safe and suitable treatment.