[Leakage of colorectal anastomosis after neoadjuvant therapy with bevacizumab. Case report].
BACKGROUND
Despite progresses achieved in last decades in treatment of rectal cancer, anastomotic leakage remains the main complication.


METHODS
We report two cases of patients affected by distal rectal cancer. Both patients received neoadjuvant therapy according to ROCHE ML 18522 experimental protocol (Xeloda, Avastin and radiotherapy). After about respectively one and two months after anterior resection of the rectum, with transanal anastomosis and temporary colostomy, presacral abscess occurred. Patients were hospitalized and started antibiotic therapy. In one case it was necessary TC-guided drainage placement.


RESULTS
Both patients had a favourable course and, after respectively 6 months and 1 year, underwent closure of colostomy.


CONCLUSIONS
"Spontaneous" gastrointestinal microperforation (small leakage) is reported during treatment with bevacizumab, a monoclonal antibody against Vascular Endothelial Growth Factor (VEGF), also in patients with non gastrointestine tumours. Probably this results from inhibition of neoangiogenesis induced.


CONCLUSIONS
Surgeons have to pay attention to adverse effects of combined neoadjuvant treatment of rectal cancer, considering temporary colostomy in presence of particular risk factors.
Scabini
S
S
Dipartimento Emato-Oncologicao, U.O.S. Chirurgia, Oncologica e dei Sistemi Impiantabili, Azienda Ospedaliera Universitaria San Martino, Genova.
Pertile
D
D
Boaretto
R
R
Rimini
E
E
Romairone
E
E
Scordamaglia
R
R
Ferrando
V
V
D000714:Anastomosis, Surgical / Q000009:adverse effects; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000209:etiology; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D012007:Rectum / Q000601:surgery*
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab