Sequential minimally invasive treatment of concomitant abdominal aortic aneurysm and colorectal cancer: a single-center experience

BACKGROUND The surgical management of concomitant occurrence of abdominal aortic aneurysm (AAA) and colorectal cancer (CCR) is still controversial. Conversely, benefits from a minimally invasive approach are well known concerning the treatment of both AAA and CCR. The aim of this study is to assess safety and feasibility of a sequential two-staged minimally invasive during the same recovery by EVAR technique and laparoscopic colorectal resection. METHODS From January 2008 to December 2020 all patients with concomitant AAA and CRC were consecutively treated by EVAR and laparoscopic colorectal resection. Perioperative data were retrospectively collected in order to evaluate short and long-term outcomes following the sequential two-staged procedures. RESULTS A total of 24 patients were included. The localization of the aneurysm was infrarenal abdominal aortic in 23 cases and in one case of common iliac artery. EVAR procedure has always been performed first. In 18 patients a percutaneous access has been used while in 6 patients a surgical access has been adopted. Twelve patients had cancer in the left colon, 9 in the right colon, and 3 patients had rectal cancer. No conversions or intraoperative complications had occurred during laparoscopic surgery. The major complications rate after EVAR and CRC surgery was 8.3% and 12.5% respectively. The mean interval between EVAR and CRC treatment was 7.8 ± 1 and the mean length of stay was 15,4 ± 3,6. No deaths occurred during hospitalization and between the procedures. Overall mortality was 20.8% with a mean follow up of 39,41 ±19.2 months. CONCLUSION Elective sequential two-staged minimally invasive treatment is a safe and feasible approach with acceptable morbidity and mortality rates and it should be adopted in current clinical practice to manage concomitant AAA and CRC.