Synchronous Colorectal Malignancy and Abdominal Aortic Aneurysm Treated With Endovascular Aneurysm Repair Followed by Laparoscopic Colectomy

Although the incidence of synchronous abdominal aortic aneurysm (AAA) and malignancies is increasing, there has been no clear consensus in the surgical treatment of such patients. The focus on surgical treatments with minimal invasiveness, such as endovascular aneurysm repair (EVAR) for AAA and laparoscopic colectomy for colorectal cancer, has increased; however, the clinical applicability of combination treatment with EVAR and laparoscopic colectomy has not been established. A 61-year-old man was diagnosed with AAA, advanced sigmoid colon cancer, and coronary artery stenosis. Because the patient also had chronic renal failure with nephrotic syndrome, among several other comorbidities, surgery was considered to be associated with high risks in this patent. Sequential treatments with percutaneous coronary intervention, EVAR, and laparoscopic colectomy were successfully performed. Staged treatment of EVAR followed by laparoscopic colectomy may be a promising strategy for high-risk patients with AAA associated with malignancy.Key words: Abdominal aortic aneurysm, Endovascular aneurysm repair, Colorectal cancer, Laparoscopic surgeryWith the aging of the general population, the prevalence of diseases associated with arterial sclerosis, such as abdominal aortic aneurysm (AAA), and that of neoplasms such as colorectal cancer (CRC), has also been increasing.¹ Therefore, the number of cases with concurrent AAA and CRC is expected to increase. However, there has been no clear consensus in the surgical treatment of such patients. The resection of CRC followed by aneurysm repair with a synthetic graft is associated with the potential risk of aneurysmal rupture during the perioperative period of the cancer operation.² Conversely, aneurysm repair prior to CRC resection may result in the delay of cancer therapy and consequent cancer progression²; there is also a possibility of aortic graft infection in the case of anastomotic leakage.¹In recent years, there has been increased focus on surgical treatments with minimal invasiveness for various diseases. In the treatment of AAA, endovascular aneurysm repair (EVAR) is a promising alternative to the conventional open graft replacement. In a large randomized study,³ EVAR was reported to achieve low operative morbidity and mortality, short hospital stay and operation time, and minimal blood loss. However, as a minimally invasive surgical procedure, the use of laparoscopic surgery for CRC is becoming more widespread. Patients who undergo laparoscopic CRC resection have significantly less blood loss and shorter hospital stays than those who undergo more invasive procedures,⁴ even though the reported oncologic outcome is equivalent to that of open surgery.⁵ Although several studies on therapy for concomitant AAA and CRC have been reported,⁶ there have only been a few reports on combination treatment with EVAR and laparoscopic colectomy.⁷ In the present report, we describe a case of synchronous AAA and sigmoid colon cancer with several other comorbidities, in which successful treatment with EVAR and laparoscopic surgery was achieved.