Bevacizumab-associated intestinal perforation and perioperative complications in patients receiving bevacizumab
Bevacizumab-associated intestinal perforation and perioperative complications in patients receiving bevacizumab
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DOI：
10.1002/ags3.12312
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发表时间：
2020-02-12
影响因子：
2.7
通讯作者：
Shimada, Mitsuo
中科院分区：
文献类型：
--
作者：
Yoshimoto, Toshiaki;Yoshikawa, Kozo;Shimada, Mitsuo
本研究的目的是介绍在贝伐单抗给药期间发生胃肠道穿孔的急诊手术病例，考虑急诊手术的适应症，并在贝伐单抗洗脱期后检查计划手术的安全性。方法(a)我们回顾性调查了7例因贝伐单抗相关肠道穿孔而接受紧急手术的患者。(b)我们回顾性调查了2008年至2018年接受新辅助治疗的104例晚期结直肠癌手术患者。结果(a)在7例因胃肠道穿孔而接受急诊手术的患者中，贝伐单抗的中位给药时间和洗脱期分别为16周和24天。除了那些非候选患者外，所有患者都进行了造口。2例患者术后出现腹部脓肿，2例患者分别死于围手术期败血症和胃肠道出血；两例患者均表现不佳。(b)在接受贝伐单抗治疗的患者（n = 45）和不使用贝伐单抗作为新辅助治疗的患者（n = 59）中，分别有31例和52例患者接受了放化疗。我们发现使用或不使用贝伐单抗与术后并发症无相关性。结论贝伐单抗继发胃肠道穿孔患者应慎重考虑手术指征。同时，在适当的停药时间后，贝伐单抗给药后的预定手术是可行的。
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.