Treatment of Concomitant Intra-abdominal Malignancy and Abdominal Aortic Aneurysm / 中国医学科学院学报

Objective To explore the outcomes in patients who receive the endovascular abdominal aortic aneurysm repair(EVAR)and have concomitant intra-abdominal malignancy.Methods Between January 2014 and December 2019,all the patients who underwent surgery for malignancy and/or EVAR were retrospectively reviewed.Results Twenty-eight abdominal aortic aneurysm(AAA)patients with concomitant intra-abdominal malignancy were included.The patients were treated by two-stage operation and the priority was given for EVAR in 21 patients.There was no perioperative death or major complications.In the follow-up,one patient developed graft thrombosis and one had type Ⅱ endoleak.There was no AAA-associated death.Conclusions It is preferred that EVAR should come first followed by operation for malignancy.Details of treatment strategy still need further investigation.

A Prospective Study to Assess the Role of Diagnostic Laparoscopy and Special Emphasis on Staging in Patients with Intraabdominal Malignancy

Aim of this study is to use staging laparoscopy to accurately define the extent of disease, direct appropriate therapy and avoid unnecessary intervention. Routine laparoscopy before laparotomy, especially in cancers which have equivocal operability helps to avoid unnecessary laparotomies. Methods: Patients with intra abdominal malignancies (carcinoma of gall bladder, stomach, and colon) who have operable disease on preoperative imaging will be taken for diagnostic laparoscopy and the findings will be corroborated with the findings in laparoscopy. Laparoscopy will include assessment of distant metastasis (liver/peritoneum/omentum), resectability of the disease, and biopsy from lesions of uncertain diagnosis. Results: Out of 35 patients taken in this study, 29 patients were operable on radiology and 6 patients had uncertain operability. Out of these 29 patients, only 15 patients were found to be resectable on diagnostic laparoscopy and underwent definitive resection. Out of the rest 14 patients, 7 had isolated peritoneal metastasis, 3 had only liver metastasis (single or multiple) and 4 had both liver and peritoneal metastasis which was confirmed on frozen section and histopathological examination. Conclusion: Diagnostic laparoscopy can reduce the number of unnecessary laparotomies that seem resectable on radiology but are found to be irresectable on laparoscopy. It can aid in diagnosis of uncertain malignancies in which image guided biopsy is not recommended in operable disease on radiology (e.g. gall bladder malignancy). It also helps to prove metastatic disease by taking biopsy from peritoneal nodules, or liver nodules along with avoiding a morbid unnecessary laparotomy.