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.