title: Perioperative complications after neoadjuvant chemotherapy with and without bevacizumab for colorectal liver metastases.
abstract: OBJECTIVE
  Bevacizumab has been shown to increase progression free and overall survival in patients with metastatic colorectal cancer. Neoadjuvant bevacizumab is commonly used in patients undergoing liver resection. Our purpose was to evaluate whether bevacizumab is associated with increased rate of perioperative complications in patients undergoing hepatic resection for colorectal liver metastases (CRLM).
  
  
  METHODS
  Retrospective analysis of patients undergoing hepatic resection for CRLM who received chemotherapy and bevacizumab (group 1, n = 134), or chemotherapy alone (group 2, n = 57). We compared demographics, surgical characteristics, and perioperative course.
  
  
  RESULTS
  Perioperative complications developed in 35 % of patients in group 1, and 47 % in group 2 (p = 0.11). Of those complications, 15 (11.2 %) in group 1, and 5 (8.8 %) in group 2 were considered major (p = 0.617). Four patients, all of whom received preoperative bevacizumab, developed enteric leaks following combined liver and bowel resection. The rate of anastomotic leak in group 1 was 10 %, compared with 0 in group 2, p = 0.56.
  
  
  CONCLUSIONS
  Neoadjuvant chemotherapy along with bevacizumab was not associated with an increased risk of postoperative complications after hepatic resection. Possible association of increased morbidity with simultaneous bowel and liver resections following bevacizumab administration was found and we recommend avoiding such treatment combination.
authors.affiliation: Department of Surgery, Tel Aviv Sourasky Medical Center, 6 Weitzman St, Tel Aviv, 64239, Israel. nir_lubezky@hotmail.com
authors.forename: Nir
authors.initials: N
authors.lastname: Lubezky
authors.forename: Evan
authors.initials: E
authors.lastname: Winograd
authors.forename: Michael
authors.initials: M
authors.lastname: Papoulas
authors.forename: Guy
authors.initials: G
authors.lastname: Lahat
authors.forename: Einat
authors.initials: E
authors.lastname: Shacham-Shmueli
authors.forename: Ravit
authors.initials: R
authors.lastname: Geva
authors.forename: Richard
authors.initials: R
authors.lastname: Nakache
authors.forename: Joseph
authors.initials: J
authors.lastname: Klausner
authors.forename: Menahem
authors.initials: M
authors.lastname: Ben-Haim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000139:chemically induced*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D000068258:Bevacizumab; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003082:Colectomy / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D012189:Retrospective Studies
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D009944:Organoplatinum Compounds; D000068258:Bevacizumab; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin