COEXISTING ABDOMINAL AORTIC-ANEURYSM AND LUNG-CANCER

Virtually no guidelines exist regarding the treatment of patients with coexisting abdominal aortic aneurysm (AAA) and carcinoma of the lung. The records of 19 patients with this challenging combination presenti ng in the last 5 years were reviewed to determine: mode of presentatio n, risk factors, stage of cancer, size of AAA, treatment, and natural history. There were 15 men and four women aged 59-77 years. All had sm oking histories ranging from 19.3 to 120 pack-years (mean: 74 pack-yea rs). Ten presented with AAA primarily, six primarily with lung cancer, and in the remaining three, lung cancer and the AAA were diagnosed in the course of workup for unrelated complaints. Among the 19 lung lesi ons, 18 biopsies were performed. There were 11 squamous cell carcinoma s, six adenocarcinomas, and one small-cell carcinoma. Aneurysm size ra nged from 3 to 9.8 cm. Eleven patients ultimately received no surgical intervention. Elective operations were performed on six patients: fou r had lung resection only, and two had both AAA repair and lung resect ion done in two stages. Two patients had urgent repair of ruptured ane urysms: one had a radiographic lung lesion consistent with cancer but was lost to follow-up. In the remaining patient, the one with the larg est aneurysm, a 3-month delay resulted in conversion from a resectable (negative mediastinoscopy) to an unresectable (malignant pleural effu sion) lung cancer. Follow-up is complete in 18 patients. Eleven have d ied of lung cancer within an average of 9.3 months (range 2-48 months) while none have died from their AAA. This experience underscores heav y cigarette smoking as the common risk factor for these two lesions an d squamous cell carcinoma as the most probable type of lung cancer exi sting in patients with both conditions. The authors' experience has sh own that when the lung cancer is resectable, treatment should be indiv idualized based on aneurysm size. Aneurysms that are either large or s ymptomatic should be addressed first; otherwise lung resection will us ually be the initial operation. When the lung cancer is unresectable, the prognosis is determined by the lung malignancy, and repair of the AAA is usually unnecessary unless required emergently.