Preoperative Chemotherapy Plus Bevacizumab and Morbidity after Resection of Colorectal Cancer Liver Metastases
DOI:
https://doi.org/10.6000/1927-7229.2014.03.01.10Keywords:
Colorectal liver metastases, bevacizumab, postoperative complications, preoperative chemotherapy, surgery complicationsAbstract
Aims and background: The addition of bevacizumab to preoperative chemotherapy is a common therapeutic practice in patients with colorectal liver metastases. The aim of the present study was to assess the effect of bevacizumab on postoperative complications after liver resection.
Methods:A retrospective analysis was performed including patients who underwent liver resection for colorectal liver metastases after receiving chemotherapy with or without bevacizumab in two hospitals. Univariate logistic regression models were used to identify predictors of postoperative morbidity in both groups of patients.
Results: A total of 76 patients were analyzed: 22 patients did not receive preoperative chemotherapy (control group), 21 patients received preoperative chemotherapy alone and 33 patients received preoperative chemotherapy in combination with bevacizumab. The median number of chemotherapy cycles received was 4 (range, 1-23) for the chemotherapy group and 7 (range, 2-36) for the chemotherapy plus bevacizumab group Morbidity rate was similar in the three groups of patients considered: 54.5 %, 47.6% and 39.4, respectively. The most common complications were infections and wound complications. The number of preoperative chemotherapy cycles received was the only clinical variable that was significantly correlated with postoperative comorbidity.
Conclusions: Our results support the evidence that the addition of bevacizumab to preoperative chemotherapy does not increase the risk of complications following surgery of colorectal liver metastases.
References
Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. Eur J Cancer 2013. http://dx.doi.org/10.1016/j.ejca.2012.12.027
Nordlinger B, Van CE, Gruenberger T, Glimelius B, Poston G, Rougier P, et al. Combination of surgery and chemotherapy and the role of targeted agents in the treatment of patients with colorectal liver metastases: recommendations from an expert panel. Ann Oncol 2009; 20: 985-92. http://dx.doi.org/10.1093/annonc/mdn735
Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004; 239: 818-25. http://dx.doi.org/10.1097/01.sla.0000128305.90650.71
National Comprehensive Cancer Network. NCCN Guideline for Treatment of Colon Cancer. http: //www nccn org/professionals/physician_gls/pdf/colon pdf 2012
Alberts SR. Update on the optimal management of patients with colorectal liver metastases. Crit Rev Oncol Hematol 2012; 84: 59-70. http://dx.doi.org/10.1016/j.critrevonc.2012.02.007
Garden OJ, Rees M, Poston GJ, Mirza D, Saunders M, Ledermann J, et al. Guidelines for resection of colorectal cancer liver metastases. Gut 2006; 55(Suppl 3): iii1-iii8. http://dx.doi.org/10.1136/gut.2006.098053
Bismuth H, Adam R, Levi F, Farabos C, Waechter F, Castaing D, et al. Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Ann Surg 1996; 224: 509-20. http://dx.doi.org/10.1097/00000658-199610000-00009
Scheele J, Stang R, Altendorf-Hofmann A, Paul M. Resection of colorectal liver metastases. World J Surg 1995; 19: 59-71. http://dx.doi.org/10.1007/BF00316981
Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer
Giantonio BJ, Catalano PJ, Meropol NJ, O'Dwyer PJ, Mitchell EP, Alberts SR, et al. Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin
Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 2004; 350: 2335-42. http://dx.doi.org/10.1056/NEJMoa032691
Saltz LB, Clarke S, Diaz-Rubio E, Scheithauer W, Figer A, Wong R, et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol 2008; 26: 2013-9. http://dx.doi.org/10.1200/JCO.2007.14.9930
Karoui M, Penna C, Amin-Hashem M, Mitry E, Benoist S, Franc B, et al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 2006; 243: 1-7. http://dx.doi.org/10.1097/01.sla.0000193603.26265.c3
Rubbia-Brandt L, Audard V, Sartoretti P, Roth AD, Brezault C, Le CM, et al. Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol 2004; 15: 460-6. http://dx.doi.org/10.1093/annonc/mdh095
Vauthey JN, Pawlik TM, Ribero D, Wu TT, Zorzi D, Hoff PM, et al. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol 2006; 24: 2065-72. http://dx.doi.org/10.1200/JCO.2005.05.3074
Aloia T, Sebagh M, Plasse M, Karam V, Levi F, Giacchetti S, et al. Liver histology and surgical outcomes after preoperative chemotherapy with fluorouracil plus oxaliplatin in colorectal cancer liver metastases. J Clin Oncol 2006; 24: 4983-90. http://dx.doi.org/10.1200/JCO.2006.05.8156
Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery
van der Pool AE, Marsman HA, Verheij J, Ten Kate FJ, Eggermont AM, Ijzermans JN, et al. Effect of bevacizumab added preoperatively to oxaliplatin on liver injury and complications after resection of colorectal liver metastases. J Surg Oncol 2012; 106: 892-7. http://dx.doi.org/10.1002/jso.23142
Kesmodel SB, Ellis LM, Lin E, Chang GJ, Abdalla EK, Kopetz S, et al. Preoperative bevacizumab does not significantly increase postoperative complication rates in patients undergoing hepatic surgery for colorectal cancer liver metastases. J Clin Oncol 2008; 26: 5254-60. http://dx.doi.org/10.1200/JCO.2008.17.7857
D'Angelica M, Kornprat P, Gonen M, Chung KY, Jarnagin WR, DeMatteo RP, et al. Lack of evidence for increased operative morbidity after hepatectomy with perioperative use of bevacizumab: a matched case-control study. Ann Surg Oncol 2007; 14: 759-65. http://dx.doi.org/10.1245/s10434-006-9074-0
Constantinidou A, Cunningham D, Shurmahi F, Asghar U, Barbachano Y, Khan A, et al. Perioperative chemotherapy with or without bevacizumab in patients with metastatic colorectal cancer undergoing liver resection. Clin Colorectal Cancer 2013; 12: 15-22. http://dx.doi.org/10.1016/j.clcc.2012.07.002
Mahfud M, Breitenstein S, El-Badry AM, Puhan M, Rickenbacher A, Samaras P, et al. Impact of preoperative bevacizumab on complications after resection of colorectal liver metastases: case-matched control study. World J Surg 2010; 34: 92-100. http://dx.doi.org/10.1007/s00268-009-0251-8
Reddy SK, Morse MA, Hurwitz HI, Bendell JC, Gan TJ, Hill SE, et al. Addition of bevacizumab to irinotecan- and oxaliplatin-based preoperative chemotherapy regimens does not increase morbidity after resection of colorectal liver metastases. J Am Coll Surg 2008; 206: 96-106. http://dx.doi.org/10.1016/j.jamcollsurg.2007.06.290
Scoggins CR, Campbell ML, Landry CS, Slomiany BA, Woodall CE, McMasters KM, et al. Preoperative chemotherapy does not increase morbidity or mortality of hepatic resection for colorectal cancer metastases. Ann Surg Oncol 2009; 16: 35-41. http://dx.doi.org/10.1245/s10434-008-0190-x
Starlinger P, Alidzanovic L, Schauer D, Maier T, Nemeth C, Perisanidis B, et al. Neoadjuvant bevacizumab persistently inactivates VEGF at the time of surgery despite preoperative cessation. Br J Cancer 2012; 107: 961-6. http://dx.doi.org/10.1038/bjc.2012.342
Ribero D, Wang H, Donadon M, Zorzi D, Thomas MB, Eng C, et al. Bevacizumab improves pathologic response and protects against hepatic injury in patients treated with oxaliplatin-based chemotherapy for colorectal liver metastases. Cancer 2007; 110: 2761-7. http://dx.doi.org/10.1002/cncr.23099
Klinger M, Eipeldauer S, Hacker S, Herberger B, Tamandl D, Dorfmeister M, et al. Bevacizumab protects against sinusoidal obstruction syndrome and does not increase response rate in neoadjuvant XELOX/FOLFOX therapy of colorectal cancer liver metastases. Eur J Surg Oncol 2009; 35: 515-20. http://dx.doi.org/10.1016/j.ejso.2008.12.013