Abdominal Cancer Risk after Endovascular Abdominal Aortic Aneurysm Repair Compared With Open Repair: A Systematic Review and Meta-Analysis.

[BACKGROUND] To evaluate, in light of existing population-based studies, whether endovascular abdominal aortic aneurysm repair (EVAR) increases the long-term incidence of abdominal cancer compared with open surgical repair.

[METHODS] A literature search was conducted using PubMed, Scopus, and Web of Science. Studies comparing EVAR and open technique were included. No date limitation was applied. The findings of the studies were evaluated using a random-effects or fixed-effects model depending on the presence of heterogeneity (I > 25%).

[RESULTS] A total of 9,734 articles were found after a database search. After reviewing the article titles and abstracts, 2 articles with 57,597 patients that met the inclusion criteria were included in the meta-analysis. Although our analysis showed that open surgery appeared to be associated with a lower incidence of abdominal cancer compared to EVAR, this result was not statistically significant (odds ratio: 0.61; 95% confidence interval 0.12-3.23; P = 0.56).

[CONCLUSION] A meta-analytic review of the available data revealed no statistically significant difference in abdominal cancer incidence between EVAR and open surgical repair. Although the hazard ratio for developing abdominal cancer after EVAR appeared modestly increased in individual cohort analyses, the absolute incidence of abdominal cancer remained low in both treatment groups. Given significant heterogeneity and the inclusion of only 2 retrospective studies in the analysis, these findings should be considered hypothesis-generating rather than transformative for clinical practice.