A systematic review and meta-analysis on the management of concomitant abdominal aortic aneurysms and renal tumours

Abstract

Objectives

The treatment of concomitant abdominal aortic aneurysms and renal tumours is controversial. The aim of this study was to ascertain which of the following three strategies, one-stage open aneurysm repair and nephrectomy, two-stage open aneurysm repair and nephrectomy or two-stage endovascular aneurysm repair and nephrectomy, is the best approach.

Methods

systematic review and meta-analysis of articles published between January 1992 and April 2021 describing the treatment of concomitant abdominal aortic aneurysms and renal tumours.

Results

A total of 1168 records were identified. After the selection process, 12 studies with data on 89 patients were included. Sixty-two patients underwent one-stage open procedures, 18 patients underwent two-stage open procedures and nine underwent two-stage endovascular procedures. The overall postoperative mortality was 0.82% (95% CI, 0.00–4.61). The postoperative mortality for one-stage open procedures was 3.09% (95% CI, 0.00–10.11). No deaths occurred in the postoperative period open two-stage procedures or two-stage endovascular procedures. The weighted postoperative morbidity for all procedures was 23.86% (95% CI, 12.64–35.08) and for open one-stage procedures was 37.40% (95% CI, 14.33–60.47). Data concerning postoperative complications of two-stage open procedures were extractable from only one patient in whom no complications were reported. Two postoperative complications were reported after two-stage endovascular procedures from a total of six patients with extractable postoperative data. We were unable to perform meta-analysis on long-term outcomes as the data were reported non-uniformly.

Conclusion

There is currently no evidence to suggest that any procedure is associated with better outcomes. However, a one-stage open approach was the most commonly used option, favoured as it avoids delaying treatment of either of the conditions. Two-stage open procedures were preferred in cases where the surgical risk of a one-stage procedure was higher than the potential benefit. For such cases, two-stage endovascular repair is becoming more popular as a less invasive approach.

Keywords

Renal tumour abdominal aortic aneurysm nephrectomy aneurysm repair endovascular aneurysm repair

Get full access to this article

View all access options for this article.

References

Diaz de Leon

Pedrosa

. Imaging and screening of kidney cancer. Radiol Clin North Am 2017; 55(6): 1235–1250.

van Walraven

Wong

Morant

, et al. Incidence, follow-up, and outcomes of incidental abdominal aortic aneurysms. J Vasc Surg 2010; 52(2): 282–289.

Zhao

Zhang

, et al. Prevalence and trends of the abdominal aortic aneurysms epidemic in general population–a meta-analysis. PLoS One 2013; 8(12): e81260.

Bray

Ferlay

Soerjomataram

, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68(6): 394–424.

Veraldi

Tasselli

De Manzoni

, et al. Surgical treatment of abdominal aortic aneurysm with concomitant renal cell carcinoma: a single-centre experience with review of the literature. J Cardiovasc Surg 2006; 47(6): 643–649.

Moláček

Houdek

Novák

, et al. Abdominal aortic aneurysm and malignancies, 2019.

Habets

Buth

Cuypers

PWM

, et al. Infrarenal abdominal aortic aneurysm with concomitant urologic malignancy: treatment results in the era of endovascular aneurysm repair. Vascular 2010; 18(1): 14–19.

Moga

CGB

Schopflocher

Harstall

. Development of a quality appraisal tool for case series studies using a modified delphi technique. Edmonton, AB: Institute of Health Economics, 2012.

DeMasi

Gregory

Snyder

, et al. Coexistent abdominal aortic aneurysm and renal carcinoma: management options. Am Surg 1994; 60(12): 961–966.

10.

Egeberg

Haug

Thoresen

JEK

, et al. Concomitant intra-abdominal disease in aortic surgery. Eur J Vasc Endovascular Surg 1997; 14: 18–23.

11.

Galt

McCarthy

Pearce

, et al. Simultaneous abdominal aortic aneurysm repair and nephrectomy for neoplasm. Am J Surg 1995; 170(2): 227–230.

12.

Hafez

El Fettouh

Novick

, et al. Management of synchronous renal neoplasm and abdominal aortic aneurysm. J Vasc Surg 2000; 32(6): 1102–1110.

13.

Konety

Shuman

Webster

, et al. Simultaneous radical nephrectomy and repair of abdominal aortic aneurysm. Urology 1996; 47(6): 813–818.

14.

Porcellini

Nastro

Bracale

, et al. Endovascular versus open surgical repair of abdominal aortic aneurysm with concomitant malignancy. J Vasc Surg 2007; 46(1): 16–23.

15.

Raso

Bellan

Rispoli

, et al. Surgical repair of abdominal aortic or iliac aneurysms associated with treatment of urological neoplasias. J Cardiovasc Surg 2000; 41(3): 469–474.

16.

Howe

Taylor

Halloran

, et al. Management of synchronous renal cell carcinoma and aortic disease. Am J Surg 1995; 170(2): 231–234.

17.

Ginsberg

Modrall

Esrig

, et al. Concurrent abdominal aortic aneurysm and urologic neoplasm: an argument for simultaneous intervention. Ann Vasc Surg 1995; 9(5): 428–433.

18.

Georgopolous

Pikoulis

Bacoyiannis

, et al. Combined abdominal aortic aneurysmectomy and other abdominal operations. Scand J Surg 2004; 93(1): 61–63.

19.

Kouvelos

Patelis

Antoniou

, et al. Management of concomitant abdominal aortic aneurysm and colorectal cancer. J Vasc Surg 2016; 63(5): 1384–1393.

20.

Antoniou

Torella

. Editor’s choice-endovascular vs. open repair for abdominal aortic aneurysm: systematic review and meta-analysis of updated peri-operative and long term data of randomised controlled trials. Eur J Vasc Endovasc Surg 2020; 59(3): 385–397.

21.

Wanhainen

Verzini

Van Herzeele

, et al. Editor’s choice - european society for vascular surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg 2019; 57(1): 8–93.

22.

Kumar

Dattani

Asaad

, et al. Meta-analysis of outcomes following aneurysm repair in patients with synchronous intra-abdominal malignancy. Eur J Vasc Endovasc Surg 2016; 52(6): 747–756.

23.

Kira

Sawada

Kudou

, et al. Successful staged management of simultaneous abdominal aortic aneurysm and renal tumor: the novel minimally invasive treatment with endovascular aneurysm repair and retroperitoneal laparoscopic radical nephrectomy in an elderly and high-risk case. Clin Pract 2012; 2(2): e45.

24.

Pattaras

Milner

. Staged minimally invasive treatment of inflammatory abdominal aortic aneurysm and renal cell carcinoma. Can J Urol 2009; 16(2): 4596–4598.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.04 MB