Outcomes After Aortic Aneurysm Repair in Patients With History of Cancer With a Nationwide Data Set

Abstract

Objective:Synchronous cancer in patients with abdominal aortic aneurysm (AAA) increases their morbidity and mortality after AAA repair. However, little is known about the history of cancer in AAA patients and its impact on mortality after AAA repair. We analyzed the incidence and type of cancer history in patients who underwent AAA repair and difference in short- and long-term mortality.Methods:Patients with intact AAA who were treated with endovascular aneurysm repair (EVAR) or open surgical repair (OSR) were selected from the Health Insurance and Review Assessment data in South Korea between 2007 and 2016. Primary end points included the 30-day and 90-day mortality and long-term mortality after AAA repair, determined by Kaplan-Meier analysis. The Cox proportional hazards models were constructed to evaluate independent predictors of mortality.Results:A total of 11,785 patients were included, of whom 1999 patients (17.0%) were diagnosed with cancer. The common cancers included stomach (21.5%), colorectal (19.1%), prostate (18.4%), and lung (11.5%). History of cancer generally had no effect on short-term mortality after AAA repair at 30 and 90 days. Further analysis also showed no difference in short-term mortality in patients with intra-abdominal and digestive cancers after both EVAR and OSR. However, 30- and 90-day mortality rates of patients with a history of lung cancer were more than twice those of patients without lung cancer (3.07% vs 1.06% [P = .0038], 6.14% vs 2.69% [P = .0016]). Furthermore, the mortality rate at the end of the study period was significantly higher in AAA patients with a history of cancer than in those without a history of cancer (21.21% vs 17.08%; P < .0001; hazard ratio, 1.31; 95% confidence interval, 1.17-1.46).Conclusions: The history of cancer in AAA patients increases long-term mortality but does not affect short-term mortality after both OSR and EVAR. Well-planned OSR and EVAR can be safely performed in patients with intact AAA and history of intra-abdominal and digestive cancers. However, AAA repair could increase both short- and long-term mortality in patients with lung cancer history, and those cases should be more carefully selected.