title: Antiangiogenic agents and late anastomotic complications.
abstract: Anticancer agents targeting circulating vascular endothelial growth factor (VEGF) (e.g., bevacizumab and aflibercept) are strong angiogenesis inhibitors. As such, they may hamper the healing process, notably in the early postoperative period. Whether antiangiogenic agents may be associated with late postoperative healing complications is less known. We reviewed three cases of patients with anastomotic complications under antiangiogenic treatment occurring more than 1 year after initial surgery and we conducted a review of the literature. We report the first case of delayed anastomotic leakage which occurred under aflibercept therapy 13 months after a bilioenteric anastomosis and two cases of delayed rectal anastomotic complications associated with bevacizumab treatment 18 and 78 months after surgery. Fifteen similar cases of late gastrointestinal anastomotic complications were found in the English literature. Antiangiogenic agents are probably not deleterious to a healed wound. However, they appear to be associated with an increased risk of complications in a subgroup of patients. According to the 18 cases reported, the main risk factors appear to be low anterior resection for rectal cancer, perioperative radiotherapy, and early postoperative leak which heals through the formation of abundant and hypervascularized granulation tissue.
authors: Department of Oncologic Surgery, Institut Gustave Roussy, 94805 Villejuif Cedex, France.
authors: Isabelle
authors: I
authors: Deshaies
authors: David
authors: D
authors: Malka
authors: Jean-Charles
authors: JC
authors: Soria
authors: Christophe
authors: C
authors: Massard
authors: Rastio
authors: R
authors: Bahleda
authors: Dominique
authors: D
authors: Elias
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000494:pharmacology; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D020533:Angiogenesis Inhibitors