title: Impact of Bevacizumab on parenchymal damage and functional recovery of the liver in patients with colorectal liver metastases.
abstract: BACKGROUND
  Little is known about the safety of the anti-VEGF antibody bevacizumab in patients undergoing resection for colorectal liver metastases (CLM). This meta-analysis evaluates the impact of bevacizumab on parenchymal damage and functional recovery in patients undergoing resection for CLM.
  
  
  METHODS
  The Medline, Embase and Cochrane Library were systematically searched for studies on preoperative chemotherapy with and without bevacizumab prior to resection of CLM. Studies that reported histological and/or clinical outcomes were eligible for inclusion. Meta-analyses were performed using a random effects model.
  
  
  RESULTS
  A total of 18 studies with a total sample size of 2430 patients (1050 patients with bevacizumab) were found. Meta-analyses showed a significant reduction in sinusoidal obstruction syndrome (SOS) (Odds ratio 0.50 [95% confidence interval 0.37, 0.67]; p < 0.001; I(2) = 0%) and hepatic fibrosis (0.61 [0.4, 0.86]; p = 0.004; I(2) = 7%) after preoperative chemotherapy with bevacizumab. The reduced incidence of posthepatectomy liver failure in patients with bevacizumab treatment just failed to reach statistical significance (0.61 [0.34, 1.07]; p = 0.08 I(2) = 6%). While there was no difference in perioperative morbidity and mortality, the incidence of wound complications was significantly increased in patients who received bevacizumab (1.81 [1.12, 2.91]; p = 0.02 I(2) = 4%).
  
  
  CONCLUSIONS
  The combination of bevacizumab with cytotoxic chemotherapy is safe but increases the incidence of wound complications after resection of CLM. The reduction of SOS and hepatic fibrosis warrant further investigation and may explain the inverse association of bevacizumab administration and posthepatectomy liver failure.
authors: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstr. 74, D-01307, Dresden, Germany.
authors: Andreas M
authors: AM
authors: Volk
authors: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstr. 74, D-01307, Dresden, Germany.
authors: Johannes
authors: J
authors: Fritzmann
authors: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstr. 74, D-01307, Dresden, Germany.
authors: Christoph
authors: C
authors: Reissfelder
authors: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstr. 74, D-01307, Dresden, Germany.
authors: Georg F
authors: GF
authors: Weber
authors: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstr. 74, D-01307, Dresden, Germany.
authors: Jürgen
authors: J
authors: Weitz
authors: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstr. 74, D-01307, Dresden, Germany. nuh.rahbari@uniklinikum-dresden.de.
authors: Nuh N
authors: NN
authors: Rahbari
mesh_terms: D000068258:Bevacizumab / Q000008:administration & dosage* / Q000009:adverse effects; D002166:Camptothecin / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D005472:Fluorouracil / Q000008:administration & dosage; D006498:Hepatectomy; D006504:Hepatic Veno-Occlusive Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000473:pathology; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary / Q000601:surgery; D020360:Neoadjuvant Therapy / Q000009:adverse effects
chemical_list: D000068258:Bevacizumab; D005472:Fluorouracil; D002166:Camptothecin