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Impact of Preoperative Bevacizumab on Complications After Resection of Colorectal Liver Metastases: Case-Matched Control Study

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Abstract

Background

Chemotherapy may increase postoperative morbidity and mortality after liver surgery. Especially bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF), could have a detrimental effect. To assess the impact of neoadjuvant bevacizumab on clinical outcome after hepatectomy for colorectal liver metastases (CRLMs) this case-matched control study was initiated.

Methods

The multicentric data collection was performed in the Swiss HPB Center of the University Hospital Zurich (CH), the Department of Digestive Surgery and Transplantation Strasbourg (F), and the Division of Hepato-biliary-pancreatic surgery of “Josep Tureta” Hospital Girona (E). Consecutive patients operated onbetween July 2005 and December 2007 due to CRLMs who received neoadjuvant chemotherapy were assessed. Patients were divided in two groups: group A had neoadjuvant chemotherapy with bevacicumab, and group B had it without bevacizumab.

Results

No differences in overall morbidity (56 vs. 40% in the bevacizumab and control groups, respectively, p = 0.23) or mortality could be documented. Similarly, the incidence of severe postoperative complications was not statistically different between the bevacizumab and control groups (31 and 18%, respectively, p = 0.31). Wound complications were comparable (11% in the bevacizumab group compared and 9% in the control group, p = 1.00). However, bevacizumab was associated with a significantly decreased incidence of postoperative hepatic insufficiency (7 vs. 20%, p = 0.03).

Conclusions

No impact on the incidence or severity of complications by bevacizumab could be shown. Bevacizumab may even reduce the incidence of liver failure after liver surgery.

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Authors and Affiliations

  1. Department of Surgery, Swiss HPB (Hepato-Pancreatico-Biliary) Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Mahfud Mahfud, Stefan Breitenstein, Ashraf Mohammad El-Badry, Andreas Rickenbacher, Panagiotis Samaras & Pierre Alain-Clavien

  2. Horten Center for Patient-Oriented Research and Knowledge Transfer, University Hospital Zurich, Zurich, Switzerland

    Milo Puhan

  3. Department of Oncology, University Hospital Zurich, Zurich, Switzerland

    Panagiotis Samaras

  4. Center de Chirurgie Viscérale et de Transplantation, Hautepierre Hospital, Strasbourg, France

    Patrick Pessaux & Daniel Jaeck

  5. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, “Josep Tureta” Hospital, Girona, Spain

    Santiago Lopez-Ben & Joan Figueras

Authors
  1. Mahfud Mahfud
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  2. Stefan Breitenstein
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  3. Ashraf Mohammad El-Badry
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  4. Milo Puhan
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Corresponding author

Correspondence to Pierre Alain-Clavien.

Additional information

Mahfud Mahfud and Stefan Breitenstein contributed equally to this work. Dr. Mafhud is a Henri Bismuth fellow who spent 4 months at each of the centers involved in the study.

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Mahfud, M., Breitenstein, S., El-Badry, A.M. et al. Impact of Preoperative Bevacizumab on Complications After Resection of Colorectal Liver Metastases: Case-Matched Control Study. World J Surg 34, 92–100 (2010). https://doi.org/10.1007/s00268-009-0251-8

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  • DOI: https://doi.org/10.1007/s00268-009-0251-8

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