Endovascular aneurysm repair for patients with disseminated cancer: A propensity-score matched study from ACS-NSQIP database from 2012-2022.

Abstract

BackgroundDisseminated cancer may complicate decision-making processes for major surgical interventions, including endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). However, the postoperative outcomes of EVAR in patients with disseminated cancer have not been well-established. This study aimed to explore the impact of preoperative disseminated cancer on 30-day outcomes of non-ruptured EVAR.MethodsPatients who underwent infrarenal EVAR were identified in ACS-NSQIP targeted database from 2012 to 2022. Exclusion criteria included age <18 years, ruptured aneurysm, acute intraoperative conversion to open repair, and emergency cases. A 1:3 propensity-score matching was used to match demographics, baseline characteristics, aneurysm diameter, distant aneurysm extent, anesthesia, and concomitant procedures between patients with and without preoperative disseminated cancer. Thirty-day postoperative EVAR outcomes were examined.ResultsThere were 154 (0.80%) patients with disseminated cancer who underwent non-ruptured EVAR. Meanwhile, 19,109 patients without disseminated cancer went under EVAR, where 462 of them were matched to all patients with disseminated cancer. After propensity-score matching, patients with and without disseminated cancer had comparable mortality rates (5.19% vs 4.76%, p = 0.83). However, patients with disseminated cancer had higher lower extremity ischemia (2.60% vs 0.43%, p = 0.04), unplanned reoperation (9.74% vs 3.90%, p = 0.01), and 30-day readmission (19.48% vs 10.61%, p = 0.01).ConclusionDisseminated cancer is significantly more prevalent among patients undergoing EVAR than the general population (0.05%), likely due to shared pathophysiology between AAA development and the incidence and progression of cancer. While EVAR is relatively safe in terms of short-term outcomes in patients with disseminated cancer, the long-term prognosis for these patients needs further investigation.