Bevacizumab-related surgical site complication despite primary tumor resection in colorectal cancer patients.
BACKGROUND
Combining conventional systemic chemotherapy with the angiogenesis inhibitor bevacizumab is now recommended as a first treatment for metastatic colorectal neoplasms. The risk for short-term postoperative complications related to bevacizumab has been assessed. Late postoperative complications related to bevacizumab have also been suggested by preliminary reports.


METHODS
We reviewed a cohort of 142 patients with previous surgery for primary colonic or rectal tumor and without evidence of local recurrence, receiving bevacizumab for metastatic disease.


RESULTS
Four patients experienced a late surgical site complication related to bevacizumab. Common features were rectal location, low anastomosis, and preoperative irradiation. Combining these three factors, the risk of a bevacizumab-related complication was 4 in 27 (14.8%); if previous history of postoperative leakage was reported, the risk was raised to 2 in 4. No complications occurred in colonic location or the non-irradiated patients. The mechanism of these complications could be ischemic lesion in post-irradiated tissues involving anastomoses.


CONCLUSIONS
We conclude that angiogenesis inhibitors should be carefully considered for patients having low colorectal anastomosis and previous irradiation.
Bège
Thierry
T
Department of Surgical Oncology, Paoli Calmettes Institute, Regional Comprehensive Cancer Center, Marseille, France. beget@hotmail.fr
Lelong
Bernard
B
Viret
Frederic
F
Turrini
Olivier
O
Guiramand
Jerome
J
Topart
Delphine
D
Moureau-Zabotto
Laurence
L
Giovannini
Marc
M
Gonçalves
Anthony
A
Delpero
Jean Robert
JR
D000038:Abscess / Q000209:etiology / Q000628:therapy; D000714:Anastomosis, Surgical / Q000009:adverse effects; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000009:adverse effects; D000068258:Bevacizumab; D003082:Colectomy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D010388:Pelvis; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068258:Bevacizumab