Meta-analysis of Outcomes Following Aneurysm Repair in Patients with Synchronous Intra-abdominal Malignancy

Area of Science:

• Vascular Surgery
• Surgical Oncology
• Evidence-Based Medicine

Background:

• Management of patients with concomitant intra-abdominal malignancy (IAM) and abdominal aortic aneurysm (AAA) presents significant clinical challenges.
• Elderly populations frequently present with both conditions, necessitating careful consideration of treatment strategies.
• Existing literature lacks comprehensive comparative outcome data for different AAA repair methods in patients with IAM.

Purpose of the Study:

• To systematically review and meta-analyze outcomes of open aortic repair (OAR) versus endovascular aneurysm repair (EVAR) in patients with concomitant IAM.
• To compare peri-operative and long-term mortality and morbidity between OAR and EVAR for AAA in the presence of IAM.

Main Methods:

• Systematic literature search of Medline and EMBASE databases.
• Inclusion of all series reporting outcomes of AAA repair (OAR or EVAR) in patients with concomitant IAM.
• Meta-analysis to assess 30-day and long-term mortality and major morbidity.

Main Results:

• 36 series comprising 543 patients were identified; colorectal malignancy was most common.
• 30-day mortality was 11% for OAR versus 0% for EVAR. 30-day major complication rates were 15.4% (OAR) and 20.4% (EVAR).
• Long-term mortality was higher in the OAR cohort (10.6%) compared to EVAR (4.6%). Non-simultaneous treatment was most common.

Conclusions:

• Open aortic repair (OAR) is associated with significant peri-operative mortality in patients with intra-abdominal malignancy (IAM).
• Endovascular aneurysm repair (EVAR) should be considered the first-line modality for AAA repair in patients with concomitant IAM.
• Further research is needed to determine optimal timing for simultaneous or staged treatment of AAA and IAM.