Annals of Surgical Oncology

, Volume 21, Issue 4, pp 1352–1360

Analysis of Bevacizumab-based Preoperative Radiochemotherapy in Patients with Locally Advanced Rectal Cancer on Surgery-associated Spectrum of Complications


    • Department of Radiooncology Kiel/LuebeckUniversity of Kiel
  • Johannes Buller
    • Department of SurgeryPaul-Gerhard-Stiftung
  • Gregor Jürgen Görtz
    • Department of SurgeryPaul-Gerhard-Stiftung
  • Michael Richter
    • Coordination Center for Clinical Trials
  • Thomas Höhler
    • Prosper Hospital Recklinghausen
  • Dirk Arnold
    • Department of Medical OncologyTumor Biology Center Freiburg
  • Tobias Keck
    • Department of SurgeryUniversity of Luebeck
  • Jürgen Dunst
    • Department of Radiooncology Kiel/LuebeckUniversity of Kiel
    • Department of Radiooncology Kiel/LuebeckUniversity of Luebeck
  • Helmut Zühlke
    • Department of SurgeryPaul-Gerhard-Stiftung
Colorectal Cancer

DOI: 10.1245/s10434-013-3412-9

Cite this article as:
Dellas, K., Buller, J., Görtz, G.J. et al. Ann Surg Oncol (2014) 21: 1352. doi:10.1245/s10434-013-3412-9



Preoperative radiochemotherapy (RCT) is a standard of care for patients with locally advanced rectal cancer (LARC; stages II and III). Results of our phase II study (BevXelOx-RT) have shown that this regimen is feasible but without a significant improvement of pathological complete response. Whether preoperatively administered bevacizumab, due to its specific toxicity profile, leads to increased rates of surgical complications is currently a subject for debate. This analysis focusses on the surgery-associated spectrum of complications.


Data from 62 patients with rectal cancer (uT3-4; N0/1, M0) of the phase II trial were analyzed. Patients received radiotherapy (50.4/1.8 Gy fractions), simultaneous bevacizumab 5 mg/kg (d1, d15, d29), and capecitabine 825 mg/m2 twice daily (d1–14, d22–35), oxaliplatin 50 mg/m2 (d1, d8, d22, d29). Four to six weeks after RCT, surgical resection was performed.


Overall, 69/69 patients underwent surgery, and 66 (95.7 %) patients had R0 resection. Surgery was mainly conducted (in 66 %) by highly experienced surgeons (>20 resections of rectal cancer/year) with differences between the institutions due to the operative procedures but without effects on the rate of R0 resection or complications. The average duration of surgery was 239 min (±10). Frequency of multivisceral resections (11 %), intraoperative (8 %) and postoperative (43 %) complications were all in the expected range. In particular, we did not observe an increased rate of postoperative bleedings (3 %). The postoperative mortality rate was 0 %.


Quantity and the kind of surgery-associated spectrum of complications followed by a preoperative bevacizumab-containing RCT regimen in patients with LARC were in line with comparable trials of bevacizumab-based approaches.

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© Society of Surgical Oncology 2013