Komori K, Okadome K, Funahashi S, Itoh H, Sugimachi K
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
J Vasc Surg. 1994 Apr;19(4):573-6. doi: 10.1016/s0741-5214(94)70028-1.
Selecting the most appropriate surgical approach for patients with abdominal aortic aneurysm (AAA) and concurrent gastric cancer remains controversial. In an attempt to develop guidelines for the management of two concurrent lesions, a retrospective review of patients with concomitant AAA and gastric cancer was undertaken.
During the period from January 1985 to December 1992, a total of 222 patients with AAA were admitted to our hospital. Among these, seven patients (3.2%) had gastric cancer and concurrent AAA. Six of the seven patients were treated surgically for both lesions with either a one- or two-stage operation. One patient underwent only an exploratory laparotomy because of the peritoneal dissemination of the gastric cancer. Four of the six patients underwent a two-stage operation. In three cases, the resection of the malignancy was performed first because the gastric cancer was diagnosed as advanced before operation. In one case, the aneurysmectomy was performed first because the aneurysm was more than 6 cm in diameter and the gastric cancer was in an early stage of development. Two of the six patients underwent a one-stage operation and a simultaneous resection was carried out by way of segregated approaches, such as the retroperitoneal approach for AAA and the transperitoneal approach for the malignant lesion.
Five of the seven patients (71.4%) are still alive. The length of follow-up for these patients ranged from 4 months to 4 years.
The principles of our surgical approaches for concomitant AAA and gastric cancer are as follows. (1) The lesion that absolutely indicates urgent operation should be operated on first. (2) If the malignant lesion is advanced, it is resected first. (3) If the malignancy is not advanced, the AAA should be resected first by the retroperitoneal approach. (4) Simultaneous resection by way of segregated approaches is useful in some patients with early gastric cancer. (5) Both lesions must be resected eventually for improvement of the long-term survival chances.
为腹主动脉瘤（AAA）合并胃癌患者选择最合适的手术方式仍存在争议。为制定针对这两种并存病变的治疗指南，我们对AAA合并胃癌患者进行了回顾性研究。
1985年1月至1992年12月期间，我院共收治222例AAA患者。其中，7例（3.2%）患有胃癌并合并AAA。7例患者中有6例接受了一期或二期手术同时治疗这两种病变。1例患者因胃癌腹膜播散仅接受了剖腹探查术。6例患者中有4例接受了二期手术。3例患者因术前诊断为进展期胃癌，先行恶性肿瘤切除术。1例患者因动脉瘤直径超过6 cm且胃癌处于早期，先行动脉瘤切除术。6例患者中有2例接受了一期手术，通过分离的方法同时进行切除，如AAA采用腹膜后途径，恶性病变采用经腹途径。
7例患者中有5例（71.4%）仍存活。这些患者的随访时间为4个月至4年。
我们针对AAA合并胃癌的手术原则如下。（1）绝对需要紧急手术的病变应先行手术。（2）如果恶性病变为进展期，则先行切除。（3）如果恶性病变不是进展期，应通过腹膜后途径先行切除AAA。（4）对于一些早期胃癌患者，采用分离方法同时切除是有用的。（5）最终必须切除两种病变以提高长期生存机会。
