Kouvelos George N, Patelis Nikolaos, Antoniou George A, Lazaris Andreas, Bali Christina, Matsagkas Miltiadis
Vascular Surgery Unit, Department of Surgery, University of Ioannina, Ioannina, Greece.
Vascular Surgery Unit, First Department of Surgery, Medical School, University of Athens, Athens, Greece.
J Vasc Surg. 2016 May;63(5):1384-93. doi: 10.1016/j.jvs.2016.01.026. Epub 2016 Mar 19.
To conduct a systematic review of the literature and perform an analysis of outcomes of treatment of concomitant colorectal cancer (CRC) and abdominal aortic aneurysm (AAA) with a focus on the different treatment options and the related therapeutic outcomes.
A review of the English-language medical literature from 1980 to 2015 was undertaken using the PubMed and EMBASE databases to identify studies reporting surgical treatment of patients with concomitant CRC and AAA. The search identified 24 articles encompassing 254 patients (81% male; mean age 73.5 ± 6.1 years).
In 96 patients (37.9%) cancer resection was performed first, followed by AAA repair at a later stage (open aortic repair [OAR], 79.2%; endovascular abdominal aortic repair [EVAR], 20.8%). Eighty-two patients (32.3%) underwent AAA repair (OAR, 47.5%; EVAR, 52.5%) before CRC resection. Seventy-one patients (27.9%) underwent combined OAR and CRC resection, and just five (1.9%) were treated with EVAR and cancer surgery in a single stage. There were eight of 96 interval AAA ruptures (8.3%), mostly in the early postoperative period concerning aneurysms >6 cm in diameter. The mean interval between the two procedures was much shorter in patients treated with EVAR than OAR (11.5 ± 1.8 days vs 103.9 ± 42.3 days). The overall 30-day mortality rate was 10.9%. Data from observational studies showed no significant differences in 30-day mortality between patients treated in one or two stages (P = .89). No mortality was recorded in any of the EVAR-treated patients. There was only one graft infection recorded (0.4%).
Among different approaches, no significant differences in 30-day outcomes among patients treated in either two or one stage were evident. EVAR showed the lowest mortality and also diminished the delay between the two procedures in <2 weeks for a two-stage approach, although it has been associated with a significant risk for thrombotic events. The coexistence of AAA and CRC seems to favor the use of EVAR in treating those patients.
对文献进行系统综述，并分析同时患有结直肠癌（CRC）和腹主动脉瘤（AAA）的患者的治疗结果，重点关注不同的治疗选择及其相关治疗结果。
使用PubMed和EMBASE数据库对1980年至2015年的英文医学文献进行综述，以识别报告同时患有CRC和AAA的患者手术治疗情况的研究。检索共识别出24篇文章，涵盖254例患者（81%为男性；平均年龄73.5±6.1岁）。
96例患者（37.9%）先进行了癌症切除术，随后在后期进行了AAA修复（开放主动脉修复[OAR]，79.2%；血管腔内腹主动脉修复[EVAR]，20.8%）。82例患者（32.3%）在CRC切除术前进行了AAA修复（OAR，47.5%；EVAR，52.5%）。71例患者（27.9%）接受了OAR和CRC联合切除术，仅有5例（1.9%）接受了EVAR和癌症手术一期治疗。96例患者中有8例（8.3%）出现了间隔期AAA破裂，大多发生在术后早期，涉及直径>6 cm的动脉瘤。接受EVAR治疗的患者两次手术之间的平均间隔时间比接受OAR治疗的患者短得多（11.5±1.8天对103.9±42.3天）。总体30天死亡率为10.9%。观察性研究数据显示，一期或二期治疗的患者30天死亡率无显著差异（P = 0.89）。接受EVAR治疗的患者均未记录到死亡。仅记录到1例移植物感染（0.4%）。
在不同的治疗方法中，一期或二期治疗的患者30天结果无明显差异。EVAR显示出最低的死亡率，并且对于两阶段治疗方法，可将两次手术之间的延迟缩短至<2周，尽管它与血栓形成事件的显著风险相关。AAA和CRC并存似乎有利于对这些患者使用EVAR。
