SURGICAL STRATEGY OF CONCOMITANT ABDOMINAL AORTIC-ANEURYSM AND GASTRIC-CANCER

Purpose: Selecting the most appropriate surgical approach for patients with abdominal aortic aneurysm (AAA) and concurrent gastric cancer re mains controversial. In an attempt to develop guidelines for the manag ement of two concurrent lesions, a retrospective review of patients wi th concomitant AAA and gastric cancer was undertaken. Methods: During the period from January 1985 to December 1992, a total of 222 patients with AAA were admitted to our hospital. Among these, seven patients ( 3.2%) had gastric cancer and concurrent AAA. Six of the seven patients were treated surgically for both lesions with either a one- or two-st age operation. One patient underwent only an exploratory laparotomy be cause of the peritoneal dissemination of the gastric cancer. Four of t he six patients underwent a two-stage operation. In three cases, the r esection of the malignancy was performed first because the gastric can cer was diagnosed as advanced before operation. In one case, the aneur ysmectomy was performed first because the aneurysm was more than 6 cm in diameter and the gastric cancer was in an early stage of developmen t. Two of the six patients underwent a one-stage operation and a simul taneous resection was carried out by way of segregated approaches, suc h as the retroperitoneal approach for AAA and the transperitoneal appr oach for the malignant lesion. Results: Five of the seven patients (71 .4%) are still alive. The length of follow-up for these patients range d from 4 months to 4 years. Conclusions: The principles of our surgica l approaches for concomitant AAA and gastric cancer are as follows. (1 ) The lesion that absolutely indicates urgent operation should be oper ated on first. (2) If the malignant lesion is advanced, it is resected first. (3) If the malignancy is not advanced, the AAA should be resec ted first by the retroperitoneal approach. (4) Simultaneous resection by way of segregated approaches is useful in some patients with early gastric cancer. (5) Both lesions must be resected eventually for impro vement of the long-term survival chances.