Surgical Management of Coincidental Gastric or Colorectal Carcinoma and Abdominal Aortic Aneurysm

Yasushi Taguchi, Tatsuo Yamazaki, Haruyuki Anzai, Takashi Matsumoto, Naoki Nagashima, Masahiko Ohata, Isamu Koyama, Ryozo Omoto

Department of Surgery, Saitama Medical School

Fifty-seven patients with non-ruptured abdominal aortic aneurysms (AAA) seen between 1991 and 1994 were reviewed. Six patients had a histologically proven gastrointestinal malignancy with AAA. The most common site of the cancers (Ca) was the stomach (4 cases), in the other two cases it was the sigmoid colon and the rectum. Three patients underwent resection of the Ca first, one the AAA first, and two the Ca only. When both Ca and AAA are diagnosed preoperatively, Ca should be resected first. For asymptomatic AAA with a diameter more than 5 cm, grafting at proper intervals following surgey is preferred. These patients were examined for preoperative risk factors, diameter of AAA, progression of Ca, complications and long-term survival. All patients were dischaged uneventfully. There were three late deaths. One of the patients died of acute cardiac failure 6 months following surgery. This patient had ischemic heart disease (IHD), anemia, renal dysfunction and pulmonary dysfunciton preoperatively. Of the other two patients, one died of carcinomatosis 7 months after surgery, the other one died of recurrence 2 years and 2 months following surgery. Both of them undewwent resection of the Ca only, because of the asymptomatic small aneurysm. Three patiens are still alive. We conclude that a two-stage operation should be performed, but that patients with progressive cancer or risk factors such as IHD need to be followed up strictly.

Key words
gastrointestinal carcinoma, abdominal aortic aneurysm, two-stage operation

Reprint requests
Yasushi Taguchi Department of Surgery, Saitama Medical School
38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-04 JAPAN

Accepted
July 10, 1996

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