Simultaneous Versus Staged Surgery for Concomitant Abdominal Aortic Aneurysm and Gastrointestinal Malignancy: A Systematic Review With Meta-Analysis.

PURPOSES: To conduct a systematic review of the literature and perform a meta-analysis to the concurrent occurrence of abdominal aortic aneurysm (AAA) and gastrointestinal (GI) cancer and compare the perioperative and long-term outcomes of simultaneous versus staged treatment strategies. METHODS: A systematic review of the current literature from 1992 to 2025 was performed using PubMed, Embase, and Cochrane Central databases to identify studies reporting surgical treatment of patients with concomitant GI cancer and AAA. RESULTS: Thirty-nine (39) articles including 641 patients were detected. Simultaneous surgery was performed in 247 patients, while staged surgery was performed in 394 patients. The average age of patients undergoing simultaneous surgery was 71.8 years (±6.4 years), while those undergoing staged surgery had an average age of 72.2 years (±4.2 years). In the simultaneous surgery group (SSG), 91 patients (36.8%) underwent AAA repair first, with 56 (22.7%) of them being open aortic repair (OAR) and 35 (14.2%) endovascular aneurysm repair (EVAR). The 30-day mortality showed no significant difference between patients treated in 1 or 2 stages. However, the 30-day complication rate was significantly higher in staged surgeries (STG) compared with SSG with an odds ratio of 0.37 (95% CI, 0.20-0.69, P = .011). Moreover, the outcomes did not differ statistically between the EVAR and OAR methods. CONCLUSIONS: Simultaneous and staged approaches to the treatment of concomitant AAA and GI cancer showed no significant differences in short- or long-term mortality or disease-related complications. However, staged procedures were associated with a higher 30-day complication rate, suggesting that simultaneous management may be safer in selected patients, particularly with the use of open repair. Prospective multicenter studies are needed to establish clear treatment guidance for this complex patient population.Clinical ImpactPatients presenting with both an abdominal aortic aneurysm and gastrointestinal malignancy require coordinated decisions about the timing and sequence of treatment. This systematic review and meta-analysis aims to optimize the management of this complex population and bring together the available evidence comparing simultaneous and staged approaches. Given the retrospective nature and limited number of comparative studies, the findings should inform individualized, multidisciplinary planning rather than establish a preferred strategy for all patients. Clinicians should consider aneurysm-related risk, cancer urgency, patient fitness, and the potential consequences of delaying either treatment.