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Sheraz R. Markar, PhD, MA, MSc, MRCS,a Alberto Vidal-Diez, PhD,b,c Viknesh Sounderajah, MRCS,a Hugh Mackenzie, PhD, MRCS,a George B. Hanna, PhD, FRCS,a Matt Thompson, PhD, FRCS,b Peter Holt, PhD, FRCS,b Jesper Lagergren, PhD, MD,d,e and Alan Karthikesalingam, PhD, MA, MSc, MRCS,a,b,c
London, United Kingdom; and Stockholm, Sweden
Objective: Endovascular aneurysm repair (EVAR) has increasingly been used as the primary treatment approach for abdominal aortic aneurysm (AAA). This study examined the hypothesis that EVAR leads to an increased risk of abdominal cancer within the radiation field compared with open AAA repair.
Methods: The nationwide English Hospital Episode Statistics database was used to identify all patients older than 50 years who received an AAA repair in 2005 to 2013. EVAR and open AAA repair groups were compared for the incidence of post-operative cancer using inverse probability weights and G-computation formula to adjust for selection bias and confounding.
Conclusions: This study suggests an increased risk of abdominal cancer after EVAR compared with open AAA repair. The differential cancer risk should be further explored in alternative national populations, and radiation exposure during EVAR should be measured as a quality metric in the assessment of EVAR centers. (J Vasc Surg 2019;69:1776-85.)
Keywords: Aneurysm; Endovascular; Open; EVAR; Cancer; Population
Endovascular aneurysm repair (EVAR) has supplanted open surgery as the most frequently employed treatment of large abdominal aortic aneurysms (AAAs).1,2 In random-ized controlled trials, EVAR has been shown to reduce short-term postoperative mortality, morbidity, and length of hospital stay compared with an open surgical approach, with equivalent longer term mortality.3-5 However, con-cerns have been raised about the “catch-up” in late