A team from Rochester, Minnesota, USA, determined the optimal management of patients with colorectal cancer and abdominal aortic aneurysm.
A total of 435 patients with available charts were reviewed.
Of these, 83 individuals with a history of concomitant colorectal cancer and abdominal aortic aneurysm between 1986 and 2000 were identified.
In 64 patients the colorectal cancer was treated first, and 44 of these patients had an abdominal aortic aneurysm less than 5 cm in diameter (average = 3.8 cm).
No abdominal aortic aneurysm ruptured in the postoperative period.
The researchers found that the median delay to colorectal cancer surgery from diagnosis was 4 days.
Twenty patients with abdominal aortic aneurysm of 5 cm or greater (average = 5.4 cm) were treated for colorectal cancer first.
In 2 of these patients (with abdominal aortic aneurysms sized 5 and 6.4 cm), the abdominal aortic aneurysm ruptured in the early postoperative period.
Median delay to colorectal cancer resection was 8 days.
Some 12 patients had both abdominal aortic aneurysm and colorectal cancer treated at the same time.
In these, the average size of the abdominal aortic aneurysm was 6.4 cm.
| Concomitant treatment seems to be a safe alternative.
| Diseases of the Colon & Rectum |
Median delay from colorectal cancer diagnosis to resection was 15 days.
No documented cases of graft infection occurred in this group; median follow-up was 3.2 years.
Seven patients underwent abdominal aortic aneurysm repair before resection of colorectal cancer; in 2 patients, colorectal cancer was found at the time of resection.
The average size of abdominal aortic aneurysm was found to be 6 cm. Median delay to treatment of colorectal cancer was 122 days, a statistically significant longer delay than in the other two groups.
Author N. N. Baxter, of the Mayo Clinic, Rochester, said on behalf of the group, "In patients with colorectal cancer and abdominal aortic aneurysm of 5 cm or more, treatment of colorectal cancer first may result in life-threatening rupture.
"However, treatment of abdominal aortic aneurysm first may significantly delay treatment of colorectal cancer.
"Concomitant treatment seems to be a safe alternative."
"If anatomically suitable, the abdominal aortic aneurysm may be considered for endovascular repair followed by a staged colon resection," it was concluded.