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Preoperative bevacizumab and surgery for colorectal liver metastases: a propensity score analysis

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Abstract

Purpose

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).

Conclusion

The present study using propensity score matching demonstrated that BBC did not impair outcomes of LR for CLM.

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Abbreviations

CRC:

Colorectal cancer

CLM:

Colorectal liver metastasis

VEGF:

Vascular endothelial growth factor

BBC:

Bevacizumab-based chemotherapy

BMI:

Body mass index

OR:

Odds ratio

SOS:

Sinusoidal obstruction syndrome

RCT:

Randomized control trial

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Authors’ contributions

DB and LS performed the study concept and design. YM performed the acquisition of data. DB, MR, and LS analyzed and interpreted the data. DB and LS drafted the manuscript. AL, KB, MR, and BM critically revised the manuscript for important intellectual content. DB and MR participated in the statistical analysis.

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Authors and Affiliations

  1. Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Rennes, France

    Damien Bergeat, Michel Rayar, Yann Mouchel, Aude Merdrignac, Bernard Meunier, Karim Boudjema & Laurent Sulpice

  2. Université de Rennes 1, Rennes, France

    Damien Bergeat, Michel Rayar, Aude Merdrignac, Bernard Meunier, Astrid Lièvre, Karim Boudjema & Laurent Sulpice

  3. Inserm, UMR991 Liver Metabolism and Cancer, Rennes, France

    Damien Bergeat, Aude Merdrignac & Laurent Sulpice

  4. INRA, UR1341 ADNC, St Gilles, France

    Damien Bergeat

  5. Service des Maladies de l’Appareil Digestif, Hôpital Pontchaillou, Rennes, France

    Astrid Lièvre

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  1. Damien Bergeat
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  2. Michel Rayar
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  3. Yann Mouchel
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Correspondence to Laurent Sulpice.

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There was no financial support for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required but the clinical data were retrospectively collected from a liver resection database and analyzed after institutional review board approval was obtained.

Electronic supplementary material

Supplementary Table 1

Univariate and multivariate analysis of Clavien ≥3 risk factors after liver resection for colorectal metastasis following chemotherapy in the propensity score-matched population (DOCX 67 kb)

Supplementary Table 2

Liver resection and postoperative outcome details in patients with a combined colorectal resection compared to patient without. (DOCX 74 kb)

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Bergeat, D., Rayar, M., Mouchel, Y. et al. Preoperative bevacizumab and surgery for colorectal liver metastases: a propensity score analysis. Langenbecks Arch Surg 402, 57–67 (2017). https://doi.org/10.1007/s00423-017-1551-3

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