Abdominal Cancer Risk after Endovascular Abdominal Aortic Aneurysm Repair Compared With Open Repair: A Systematic...

Area of Science:

• Vascular Surgery
• Oncology
• Medical Statistics

Background:

• Abdominal aortic aneurysm repair is a common procedure with two main surgical approaches: endovascular (EVAR) and open repair.
• Concerns exist regarding the long-term oncological safety of EVAR compared to open repair.
• Existing population-based studies provide a basis for further investigation into cancer incidence.

Purpose of the Study:

• To compare the long-term incidence of abdominal cancer following endovascular abdominal aortic aneurysm repair (EVAR) versus open surgical repair.
• To synthesize evidence from existing studies to inform clinical decision-making regarding cancer risk.
• To evaluate the oncological outcomes associated with different abdominal aortic aneurysm repair techniques.

Main Methods:

• A comprehensive literature search was performed across PubMed, Scopus, and Web of Science databases.
• Included studies directly compared EVAR and open surgical repair for abdominal aortic aneurysms, with no date restrictions.
• Meta-analysis was conducted using random-effects or fixed-effects models based on identified heterogeneity (I² > 25%).

Main Results:

• The meta-analysis included two studies encompassing 57,597 patients after an initial search yielded 9734 articles.
• Open surgery showed a trend towards lower abdominal cancer incidence compared to EVAR, but this difference was not statistically significant (OR: 0.61; 95% CI 0.12-3.23; p=0.56).
• The absolute incidence of abdominal cancer was low in both treatment groups.

Conclusions:

• Current evidence indicates no statistically significant difference in abdominal cancer incidence between EVAR and open surgical repair.
• While some analyses suggested a modestly increased hazard ratio for cancer after EVAR, the overall absolute risk remains low.
• Due to significant heterogeneity and the limited number of retrospective studies, findings are considered hypothesis-generating and require further validation for clinical practice.