MANAGEMENT OF CONCOMITANT ABDOMINAL AORTIC-ANEURYSM AND GASTROINTESTINAL MALIGNANCY

Selecting the most appropriate surgical approach for patients with abd ominal aortic aneurysm (AAA) and gastrointestinal malignancy remains c ontroversial. In an attempt to develop guidelines for the management o f patients with these two simultaneous lesions, a retrospective review of patients who had concomitant AAA and gastrointestinal malignancy w as undertaken. During the period from January 1985 to February 1993, 2 29 patients with AAA were admitted to our hospital. Among these, 19 pa tients (8%) had a gastrointestinal malignancy together with AAA and we re divided into 2 groups. Group I was composed of 11 patients who unde rwent either a 1- or a 2-stage operation for both lesions. Group II wa s composed of eight patients who either underwent an operation for one lesion (six patients) or did not have any operation (two patients). A mong group I, six patients underwent the two-stage operation. In four of the six patients, the malignancy was resected first. In the remaini ng two patients, the aneurysmectomy was performed first, because, in o ne patient, the aneurysm was more than 6 cm in diameter, and, in the o ther patient, the aneurysm was a saccular type. Among group I, five pa tients (two patients with gastric cancer, and one patient each with es ophageal cancer, rectal cancer, and malignant lymphoma of the stomach) underwent a one-stage operation. In three of the five patients (two p atients with gastric cancer and one patient with esophageal cancer), s imultaneous resection was carried out by using segregated approaches, namely, the retroperitoneal approach for AAA and the transperitoneal a pproach for malignancy. Although the clinical characteristics of the p atients were different, 8 of the 11 patients (73%) in group I are stil l alive, whereas only 1 of the 8 patients (13%) in group II is still a live. The principles of our surgical approaches for concomitant AAA an d gastrointestinal malignancy are as follows: (1) The lesion that abso lutely indicated urgent surgery was resected first. (2) If both lesion s were asymptomatic, the malignancy was resected first. (3) Simultaneo us resection using different approaches was useful in some patients wi th concomitant upper early gastrointestinal malignancy. (4) Both lesio ns need to be resected eventually for better long-term survival.