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Medline ® Abstract for Reference 88

of 'Toxicity of molecularly targeted antiangiogenic agents: Non-cardiovascular effects'

Bevacizumab-related surgical site complication despite primary tumor resection in colorectal cancer patients.
Bège T, Lelong B, Viret F, Turrini O, Guiramand J, Topart D, Moureau-Zabotto L, Giovannini M, Gonçalves A, Delpero JR
Ann Surg Oncol. 2009;16(4):856. Epub 2009 Jan 21.
BACKGROUND: Combining conventional systemic chemotherapy with the angiogenesis inhibitor bevacizumab is now recommended as a first treatment for metastatic colorectal neoplasms. The risk for short-term postoperative complications related to bevacizumab has been assessed. Late postoperative complications related to bevacizumab have also been suggested by preliminary reports.
METHODS: We reviewed a cohort of 142 patients with previous surgery for primary colonic or rectal tumor and without evidence of local recurrence, receiving bevacizumab for metastatic disease.
RESULTS: Four patients experienced a late surgical site complication related to bevacizumab. Common features were rectal location, low anastomosis, and preoperative irradiation. Combining these three factors, the risk of a bevacizumab-related complication was 4 in 27 (14.8%); if previous history of postoperative leakage was reported, the risk was raised to 2 in 4. No complications occurred in colonic location or the non-irradiated patients. The mechanism of these complications could be ischemic lesion in post-irradiated tissues involving anastomoses.
CONCLUSION: We conclude that angiogenesis inhibitors should be carefully considered for patients having low colorectal anastomosis and previous irradiation.
Department of Surgical Oncology, Paoli Calmettes Institute, Regional Comprehensive Cancer Center, Marseille, France. beget@hotmail.fr