title: Bevacizumab-related surgical site complication despite primary tumor resection in colorectal cancer patients.
abstract: 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.
authors.affiliation: Department of Surgical Oncology, Paoli Calmettes Institute, Regional Comprehensive Cancer Center, Marseille, France. beget@hotmail.fr
authors.forename: Thierry
authors.initials: T
authors.lastname: Bège
authors.forename: Bernard
authors.initials: B
authors.lastname: Lelong
authors.forename: Frederic
authors.initials: F
authors.lastname: Viret
authors.forename: Olivier
authors.initials: O
authors.lastname: Turrini
authors.forename: Jerome
authors.initials: J
authors.lastname: Guiramand
authors.forename: Delphine
authors.initials: D
authors.lastname: Topart
authors.forename: Laurence
authors.initials: L
authors.lastname: Moureau-Zabotto
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
authors.forename: Anthony
authors.initials: A
authors.lastname: Gonçalves
authors.forename: Jean Robert
authors.initials: JR
authors.lastname: Delpero
mesh_terms: 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
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068258:Bevacizumab