COEXISTENT ABDOMINAL AORTIC-ANEURYSM AND RENAL-CARCINOMA - MANAGEMENTOPTIONS

Renal carcinoma (RCA) presenting in association with abdominal aortic aneurysm (AAA) is extremely rare, with only sporadic case reports prev iously described. The management of six cases of AAA and concomitant R CA presenting to a single institution from March, 1991 through Decembe r, 1993 was reviewed and management options considered. AAAs ranged in size from 4.5-7.0 cm (mean, 5.6 cm). Three left renal carcinomas were resected via a retroperitoneal approach simultaneous to repair of the AAA. One right renal carcinoma was resected in combination with repai r of an AAA through a transperitoneal approach. The fifth case was man aged by left nephrectomy, followed by interval aneurysmectomy, and the sixth case was managed by nonsurgical methods because of the presence of widely metastatic disease. Renal malignancies included five renal cell carcinomas and one transitional cell carcinoma. Three patients re main free of disease 8-11 months postoperatively, and one patient had metastatic disease detected 19 months postoperatively. Two deaths have occurred; one due to a massive CVA 1 month following a combined aneur ysmectomy and left nephrectomy, and a second due to unknown etiology i n the patient managed non-surgically. No peripheral vascular or aortic graft related complications have occurred. The treatment of AAA and R CA should be governed by the size of the AAA, the location of the canc er, and the extent of malignant disease. Simultaneous resection is saf e and effective in patients with coexistent AAA and renal cancer. Left sided tumors should be resected via a retroperitoneal approach that a lso provides excellent exposure for simultaneous AAA resection. Patien ts with right sided tumours or with preoperative evidence of intraperi toneal tumor spread should be managed via a transperitoneal approach, which allows access for nephrectomy, exploration, and simultaneous sta ndard aneurysmectomy.