Meta-analysis of long-term survival after elective endovascular or open repair of abdominal aortic aneurysm.

BACKGROUND: Endovascular aneurysm repair (EVAR) has become the preferred strategy for elective repair of abdominal aortic aneurysm (AAA) for many patients. However, the superiority of the endovascular procedure has recently been challenged by reports of impaired long-term survival in patients who underwent EVAR. A systematic review of long-term survival following AAA repair was therefore undertaken. METHODS: A systematic review was performed according to PRISMA guidelines. Articles reporting short- and/or long-term mortality of EVAR and open surgical repair (OSR) of AAA were identified. Pooled overall survival estimates (hazard ratios (HRs) with corresponding 95 per cent c.i. for EVAR versus OSR) were calculated using a random-effects model. Possible confounding owing to age differences between patients receiving EVAR or OSR was addressed by estimating relative survival. RESULTS: Some 53 studies were identified. The 30-day mortality rate was lower for EVAR compared with OSR: 1·16 (95 per cent c.i. 0·92 to 1·39) versus 3·27 (2·71 to 3·83) per cent. Long-term survival rates were similar for EVAR versus OSR (HRs 1·01, 1·00 and 0·98 for 3, 5 and 10 years respectively; P = 0·721, P = 0·912 and P = 0·777). Correction of age inequality by means of relative survival analysis showed equal long-term survival: 0·94, 0·91 and 0·76 at 3, 5 and 10 years for EVAR, and 0·96, 0·91 and 0·76 respectively for OSR. CONCLUSION: Long-term overall survival rates were similar for EVAR and OSR. Available data do not allow extension beyond the 10-year survival window or analysis of specific subgroups.

Involvement of the omental lymphoid organ in the induction of peritoneal immunity against tumor cells.

The omental lymphoid organ (OLO) is a part of the greater omentum composed of vascularized spots containing lymphocytes, plasma cells and macrophages located in a regular pattern between fat cells. To gain insight in the involvement of the OLO in the induction of immunity against tumor cells in the peritoneal cavity, we studied the penetration of tumor cells into the OLO after intraperitoneal, subcutaneous and intravenous injection. Furthermore we analyzed the tumoricidal activity of macrophages isolated from the OLO. Our results indicate that the OLO is only infiltrated by tumor cells directly from the peritoneal cavity, but not by subcutaneously or intravenously injected tumor cells unless they have reached the peritoneal cavity. Bromodeoxy-uridine labelled tumor cells can be detected in the OLO within 10 min after i.p. injection. The penetration is facilitated by the induction of fenestrations between the mesothelial cells (lining the OLO) after intraperitoneal injection of the tumor cells. These fenestrations can also be seen after nonspecific stimulation of the peritoneal cavity. Macrophages isolated from the OLO of mice immunized against syngeneic as well as allogeneic tumor cells express a significant cytotoxicity, which (at least in the syngeneic situation) precedes the cytotoxicity of the macrophages isolated from the peritoneal cavity. In conclusion, our data support the hypothesis that immune reactions against intraperitoneally injected tumor cells are initiated in the OLO leading to 'peritoneal immunity' against these tumor cells.