G F Veraldi1, S Tasselli, G De Manzoni, C Cordiano. 1. 1st Division of General Surgery, University of Verona, Civile Maggiore Hospital, Verona, Italy. gianfranco.veraldi@azosp.vr.it
Abstract
AIM: The association between abdominal aortic aneurysm (AAA) and renal cancer is becoming more frequent, raising several questions about therapeutic and surgical strategies of management for both diseases. METHODS: Between October 1988 and May 2004, 913 AAA patients underwent surgical or endovascular repair at the I Division of General Surgery of the University of Verona (Italy). In 61 cases (6.7%) an association with a solid neoplasm was found; in 12 cases (1.3%) the neoplasm was a renal cell carcinoma. RESULTS: Ten patients underwent a simultaneous approach to AAA and renal cancer, with aneurismectomy performed first. In 2 cases a two-stage procedure was preferred; 1 patient underwent aneurismectomy first for AAA rupture while a second patient was even affected by gastric cancer and was submitted to nephrectomy and total gastrectomy as primary procedures. There was no mortality and only one postoperative complication was registered. CONCLUSIONS: A simultaneous surgical approach can be done safely, performing aneurismectomy as first step without significant risk of graft infection. Simultaneous treatment has the advantage of avoiding a second major abdominal procedure and eliminate the risk of postoperative aortic aneurysm rupture. Performing a two-stage approach, the procedure for the disease regarded as life-threatening is performed first. Priority should be given to renal cell neoplasm in selected cases.
AIM: The association between abdominal aortic aneurysm (AAA) and renal cancer is becoming more frequent, raising several questions about therapeutic and surgical strategies of management for both diseases. METHODS: Between October 1988 and May 2004, 913 AAA patients underwent surgical or endovascular repair at the I Division of General Surgery of the University of Verona (Italy). In 61 cases (6.7%) an association with a solid neoplasm was found; in 12 cases (1.3%) the neoplasm was a renal cell carcinoma. RESULTS: Ten patients underwent a simultaneous approach to AAA and renal cancer, with aneurismectomy performed first. In 2 cases a two-stage procedure was preferred; 1 patient underwent aneurismectomy first for AAA rupture while a second patient was even affected by gastric cancer and was submitted to nephrectomy and total gastrectomy as primary procedures. There was no mortality and only one postoperative complication was registered. CONCLUSIONS: A simultaneous surgical approach can be done safely, performing aneurismectomy as first step without significant risk of graft infection. Simultaneous treatment has the advantage of avoiding a second major abdominal procedure and eliminate the risk of postoperative aortic aneurysm rupture. Performing a two-stage approach, the procedure for the disease regarded as life-threatening is performed first. Priority should be given to renal cell neoplasm in selected cases.