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Castelli P. 1, Caronno R. 1, Piffaretti G. 1, Tozzi M. 1, Lomazzi C. 1, Boni L. 2, Dionigi G. 2, Dionigi R. 2
1 Vascular Surgery Unit, Department of Surgery University of Insubria, Varese, Italy
2 General Surgery Unit, Department of Surgery University of Insubria, Varese, Italy
Aim. Controversy surrounds the best surgical treatment of simultaneous intra-abdominal aortic and neoplastic diseases in order to establish which disease should have the priority. The theoretical increased risk of graft infection, despite little evidence in literature, remains the main argument against synchronous surgery.
Methods. During the last 15 years we performed about 700 aortic surgical procedures, 512 of them for abdominal aortic aneurysm. We observed 20 (3%) patients affected by abdominal aortic aneurysm and concomitant abdominal tumors: 9 (45%) renal cell carcinoma, 8 (40%) tumors of the urinary bladder, 1 gastric cancer, 1 adrenal carcinoma and 1 uterine carcinoma. We had 19 male patients and mean age was 70 years (range 52-79); 16 patients (80%) had both diseases occasionally detected during preoperative spiral CT staging. Mean aneurysm diameter was 65 mm (range 40-170). The most common aortic replacement was a tube graft (11 patients, 55%); 16 patients underwent single stage resection of the aneurysm and the tumor; 4 (20%) of them had emergency repair for a ruptured aneurysm.
Results. We observed 2 (20%) postoperative death after emergency repair for ruptured abdominal aortic aneurysm. Mean hospitalization was 17 days (range 12-40); during the follow-up we did not observed graft infection while 6 patients (33%) died, most of all for recurrency and disseminated cancer disease.
Conclusions. We believe simultaneous surgical approach to co-existing diseases may represent a safe, suitable treatment. Our experience confirmed that an increased risk of graft infection or mortality rate with combined procedures is unproven.