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. 2020 Feb 12;4(2):151-155.
doi: 10.1002/ags3.12312. eCollection 2020 Mar.

Bevacizumab-associated intestinal perforation and perioperative complications in patients receiving bevacizumab

Toshiaki Yoshimoto  1 , Kozo Yoshikawa  1 , Jun Higashijima  1 , Tomohiko Miyatani  1 , Takuya Tokunaga  1 , Masaaki Nishi  1 , Chie Takasu  1 , Hideya Kashihara  1 , Yukako Takehara  1 , Mitsuo Shimada  1
Affiliations

Bevacizumab-associated intestinal perforation and perioperative complications in patients receiving bevacizumab

Toshiaki Yoshimoto et al. Ann Gastroenterol Surg. .

Abstract

Aim: The purposes of this study are to present cases of emergency surgery in which gastrointestinal perforation occurred during bevacizumab administration, consider the indications for emergency surgery, and examine the safety of scheduled surgery after a washout period for bevacizumab.

Methods: (a) We retrospectively investigated seven patients who underwent emergency surgery for bevacizumab-associated intestinal perforation. (b) We investigated 104 patients with advanced colorectal cancer treated with neoadjuvant therapy who underwent surgery from 2008 to 2018, retrospectively.

Results: (a) In the seven patients undergoing emergency surgery for gastrointestinal perforation, the median bevacizumab administration and washout periods were 16 weeks and 24 days, respectively. A stoma was created in all patients except in those who were not candidates. Two patients developed postoperative abdominal abscesses, and two patients died from perioperative sepsis and gastrointestinal bleeding, respectively; both of these patients had poor performance status. (b) In patients receiving bevacizumab (n = 45) and patients treated with bevacizumab-free regimens as neoadjuvant therapy (n = 59), 31 and 52 patients received chemoradiotherapy, respectively. We found no correlation with postoperative complications with or without bevacizumab.

Conclusion: The surgical indications should be considered carefully in patients with gastrointestinal perforation secondary to bevacizumab administration. Meanwhile, after appropriate cessation time, scheduled surgery following bevacizumab administration is feasible.

Keywords: bevacizumab; cancer; emergencies; perforation; postoperative complications.

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Conflict of interest statement

Funding: None. Conflicts of Interest: Authors declare no conflicts of interest for this article. Author Contribution: Toshiaki Yoshimoto: Manuscript writing, analysis, operating surgeon. Kozo Yoshikawa: Manuscript editor, operating surgeon. Jun Higashijima: Operating surgeon. Tomohiko Miyatani, Takuya Tokunaga, Masaaki Nishi, Chie Takasu, Hideya Kashihara and Yukako Takehara: Attending physicians of the presented patient. Mitsuo Shimada: Supervisor. Ethical Approval: All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki declaration of 1964 and later revisions (Review board: Tokushima clinical trial management system (ToCMS); approval number: 3215). Informed consent or substitute for it was obtained from all patients for being included in the study.

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