Originally published as JCO Early Release 10.1200/JCO.2008.17.7857 on October 14 2008

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Preoperative Bevacizumab Does Not Significantly Increase Postoperative Complication Rates in Patients Undergoing Hepatic Surgery for Colorectal Cancer Liver Metastases

Susan B. Kesmodel, Lee M. Ellis, E. Lin, George J. Chang, Eddie K. Abdalla, Scott Kopetz, Jean-Nicolas Vauthey, Miguel A. Rodriguez-Bigas, Steven A. Curley, Barry W. Feig

From the Departments of Surgical Oncology, Cancer Biology, Biostatistics, and Cancer Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX

Corresponding author: Barry W. Feig, MD, Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 444, Houston, TX 77030; e-mail: bwfeig{at}mdanderson.org

Purpose Although bevacizumab (BV) increases survival rates when used with chemotherapy (CTX) in patients who have metastatic colorectal cancer (CRC), an increase in wound complications has been observed in patients who undergo surgery while receiving BV. We therefore evaluated whether neoadjuvant BV is associated with an increase in postoperative complications in patients undergoing surgery for CRC liver metastases.

Patients and Methods Two subgroups of patients who received neoadjuvant CTX + BV (n = 81) or CTX alone (n = 44) were identified from a database of patients who underwent surgery for CRC liver metastases. Univariate and multivariate logistic regression models were used to evaluate the association of patient and tumor characteristics, neoadjuvant therapy, and operative factors with postoperative complications.

Results Postoperative complications developed in 40 patients (49%) who received CTX + BV and 19 patients (43%) who received CTX. The median time from BV discontinuation to surgery was 58 days (range, 31 to 117 days). No significant associations were identified between BV use and timing of BV discontinuation and postoperative complications. On multivariate analysis, lower serum albumin and concomitant surgical procedures were associated with an increased risk of developing any complication (P = .035 and .023, respectively), and lower serum albumin was associated with hepatobiliary complications (P = .016).

Conclusion Neither the use of BV nor timing of BV administration was associated with an increase in complication rates. These data suggest that the combination of BV with neoadjuvant CTX in patients who have CRC liver metastases does not increase surgical complications. To determine the optimal timing of surgery in patients receiving neoadjuvant BV, confirmatory prospective studies are required.

published online ahead of print at www.jco.org on October 13, 2008.

Presented in part at the 60th Annual Cancer Symposium of the Society of Surgical Oncology, March 15-18, 2007, Washington, DC.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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Related Correspondence

• Bevacizumab and Postoperative Complications After Hepatic Surgery for Colorectal Metastases
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  JCO 2009 27: 1917 [Full Text]
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This article has been cited by other articles:

				N. J. Petrelli Bevacizumab and Postoperative Complications After Hepatic Surgery for Colorectal Metastases J. Clin. Oncol., April 10, 2009; 27(11): 1917 - 1917. [Full Text] [PDF]

				M. M. Kemeny How Many Patients and How Many Complications Does It Take to Decide if a Drug Is Safe to Use Before Surgery? J. Clin. Oncol., April 10, 2009; 27(11): 1917 - 1918. [Full Text] [PDF]