Article

Annals of Surgical Oncology

, Volume 14, Issue 2, pp 759-765

First online:

Lack of Evidence for Increased Operative Morbidity After Hepatectomy with Perioperative Use of Bevacizumab: A Matched Case-Control Study

  • Michael D’AngelicaAffiliated withDepartment of Surgery, Memorial Sloan-Kettering Cancer Center Email author 
  • , Peter KornpratAffiliated withDepartment of Surgery, Memorial Sloan-Kettering Cancer Center
  • , Mithat GonenAffiliated withDepartment of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center
  • , Ki-Young ChungAffiliated withDepartment of Medical Oncology, Memorial Sloan-Kettering Cancer Center
  • , William R. JarnaginAffiliated withDepartment of Surgery, Memorial Sloan-Kettering Cancer Center
  • , Ronald P. DeMatteoAffiliated withDepartment of Surgery, Memorial Sloan-Kettering Cancer Center
  • , Yuman FongAffiliated withDepartment of Surgery, Memorial Sloan-Kettering Cancer Center
  • , Nancy KemenyAffiliated withDepartment of Medical Oncology, Memorial Sloan-Kettering Cancer Center
  • , Leslie H. BlumgartAffiliated withDepartment of Surgery, Memorial Sloan-Kettering Cancer Center
    • , Leonard B SaltzAffiliated withDepartment of Medical Oncology, Memorial Sloan-Kettering Cancer Center

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Abstract

Background

Bevacizumab (bev) is a humanized monoclonal antibody that targets vascular endothelial growth factor (VEGF). Perioperative bev is now commonly used in patients undergoing hepatic resection. Little is known, however, about the safety of perioperative bev use in the setting of hepatic resection.

Methods

Computerized pharmacy records were used to identify all patients who received bev between January 2004 and June 2005. Patients who underwent hepatectomy for colorectal metastases and received bev within 12 weeks of surgery were identified and compared with a group of matched historical controls.

Results

Thirty-two patients underwent hepatic resection of colorectal cancer metastases and received bev within the specified perioperative period. Sixteen patients received bev before surgery and 24 received bev after surgery. A subset of eight patients received bev both before and after surgery. The median time between bev administration and surgery was 6.9 weeks before (range, 3–15 weeks) and 7.4 weeks after (range, 5–15 weeks). Perioperative complications occurred in 13 patients (40.6%), two of which were considered major complications. There was no statistically significant difference in perioperative morbidity and severity of complications when compared with a set of matched controls.

Conclusions

Clinical experience thus far does not indicate a statistically significantly increased risk of perioperative complications with the incorporation of bev into pre- and/or postoperative treatment paradigms. Given the long half-life of bev and the potential for anti-VEGF therapy to impede wound healing and/or liver regeneration, we continue to favor a window of 6 to 8 weeks between bev administration and surgery.

Keywords

Colorectal metastases Hepatectomy Bevacizumab Bev Perioperative morbidity