title: Preoperative bevacizumab and surgery for colorectal liver metastases: a propensity score analysis.
abstract: OBJECTIVE
  Bevacizumab associated with conventional chemotherapy has become standard care in the management of metastatic colorectal cancer. However, its impact on outcomes after liver resections (LRs) remains debated. The aim of this study was to evaluate the impact of neoadjuvant bevacizumab-based chemotherapy (BBC) on postoperative outcomes of LR for colorectal liver metastasis (CLM) using a validated approach.
  
  
  METHODS
  All patients who received neoadjuvant therapy for CLMs between January 2005 and May 2011 were included. Risk factors for major complications (Clavien ≥3) were analyzed by univariate and multivariate analysis. Evaluation of BBC's impact on morbidity was conducted after a propensity score adjustment on factors identified to influence major complications (MCs).
  
  
  RESULTS
  LR for CLMs after neoadjuvant chemotherapy was performed in 199 patients (127 men and 72 women). Major LR was performed on 111 patients (55.78%), and MCs occurred in 41 cases (20.6%). After multivariate analyses, major LR (OR 2.85; 95% CI 1.29-6.85; P = 0.013) and combined resections of both the primary tumor and CLMs (OR 7.12; 95% CI: 2.6-20.5; P < 0.001) were independent predictive factors for MCs. After a propensity score matching, 56 patients with a BBC regimen were compared to 112 patients without BBC. No difference in terms of biliary fistula occurrence (P = 0.94) or 90-day mortality (P = 0.66) was found. Both in the univariate and multivariate analyses, BBC was not associated with MCs (P = 0.95).
  
  
  CONCLUSIONS
  The present study using propensity score matching demonstrated that BBC did not impair outcomes of LR for CLM.
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Rennes, France.|Université de Rennes 1, Rennes, France.|Inserm, UMR991 Liver Metabolism and Cancer, Rennes, France.|INRA, UR1341 ADNC, St Gilles, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Bergeat
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Rennes, France.|Université de Rennes 1, Rennes, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Rayar
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Rennes, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Mouchel
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Rennes, France.|Université de Rennes 1, Rennes, France.|Inserm, UMR991 Liver Metabolism and Cancer, Rennes, France.
authors.forename: Aude
authors.initials: A
authors.lastname: Merdrignac
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Rennes, France.|Université de Rennes 1, Rennes, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Meunier
authors.affiliation: Université de Rennes 1, Rennes, France.|Service des Maladies de l'Appareil Digestif, Hôpital Pontchaillou, Rennes, France.
authors.forename: Astrid
authors.initials: A
authors.lastname: Lièvre
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Rennes, France.|Université de Rennes 1, Rennes, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Boudjema
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Rennes, France. laurent.sulpice@chu-rennes.fr.|Université de Rennes 1, Rennes, France. laurent.sulpice@chu-rennes.fr.|Inserm, UMR991 Liver Metabolism and Cancer, Rennes, France. laurent.sulpice@chu-rennes.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Sulpice
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000074322:Antineoplastic Agents, Immunological / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000628:therapy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000074322:Antineoplastic Agents, Immunological; D000068258:Bevacizumab
keywords: Colorectal cancer; Liver metastases; Liver resection; Mortality; Outcomes