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Bevacizumab Doubles the Early Postoperative Complication Rate after Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Peritoneal Carcinomatosis of Colorectal Origin

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patients with stage IV colorectal cancer and peritoneal carcinomatosis are increasingly treated with curative intent and perioperative systemic chemotherapy combined with targeted therapy. The aim of this study was to analyze the potential impact of bevacizumab on early morbidity after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal carcinomatosis of colorectal origin.

Methods

From 2004 to 2010, in three referral centers, 182 patients with colorectal carcinomatosis were treated with complete cytoreduction followed by HIPEC after either preoperative systemic chemotherapy alone or in combination with bevacizumab. Because there was no control on treatment allocation, propensity score methods were used to control for this bias.

Results

The median time from discontinuation of bevacizumab to HIPEC was 7 weeks (range 6–10 weeks). Major morbidity was greater in the bevacizumab group (34 vs. 19 %, p = 0.020). Nine patients died postoperatively, 5 (6.2 %) in the bevacizumab group (n = 80) and 4 (3.9 %) in the group treated with chemotherapy alone (n = 102) (p = 0.130). The rate of digestive fistulas was greater in the bevacizumab group, although not statistically significant (18 vs. 10 %, p = 0.300). The effect of bevacizumab on major morbidity (including death) was found to be statistically significant (odds ratio 2.28, 95 % confidence interval 1.05–4.95) (p = 0.04).

Conclusions

Administration of bevacizumab before surgery with complete cytoreduction followed by HIPEC for colorectal carcinomatosis is associated with twofold increased morbidity. The oncologic benefit of bevacizumab before HIPEC remains to be evaluated.

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Digestive Disease, Hôpital Lariboisière-AP-HP & Université Diderot-Paris 7, Paris, France

    Clarisse Eveno MD, PhD & Marc Pocard MD, PhD

  2. UMR INSERM 965-Paris 7 “Angiogenèse et recherche translationnelle”, Hôpital Lariboisière-AP-HP, Paris, France

    Clarisse Eveno MD, PhD & Marc Pocard MD, PhD

  3. Department of Digestive Surgery, Centre Hospitalier Lyon Sud, Université Lyon, Pierre Bénite, France

    Guillaume Passot MD & Olivier Glehen MD, PhD

  4. Department of Digestive Surgery, Université Lyon, Lyon, France

    Guillaume Passot MD & Olivier Glehen MD, PhD

  5. Department of Surgical Oncology, Institut Gustave Roussy, Villejuif Cedex, France

    Diane Goéré MD, PhD & Dominique Elias MD, PhD

  6. Department of Abdominal & Interventional Imaging, Hôpital Lariboisière-AP-HP & Université Diderot-Paris 7, Paris, France

    Philippe Soyer MD, PhD

  7. Department of Intensive Care, Hôpital Lariboisière-AP-HP & Université Diderot-Paris 7, Paris, France

    Etienne Gayat MD, PhD

  8. Department of Biostatistics and Clinical Epidemiology, Hôpital Saint-Louis-AP-HP & Université Diderot-Paris 7, Paris, France

    Etienne Gayat MD, PhD

Authors
  1. Clarisse Eveno MD, PhD
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  2. Guillaume Passot MD
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  3. Diane Goéré MD, PhD
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  4. Philippe Soyer MD, PhD
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  5. Etienne Gayat MD, PhD
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  6. Olivier Glehen MD, PhD
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  7. Dominique Elias MD, PhD
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  8. Marc Pocard MD, PhD
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Correspondence to Clarisse Eveno MD, PhD.

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Eveno, C., Passot, G., Goéré, D. et al. Bevacizumab Doubles the Early Postoperative Complication Rate after Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Peritoneal Carcinomatosis of Colorectal Origin. Ann Surg Oncol 21, 1792–1800 (2014). https://doi.org/10.1245/s10434-013-3442-3

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  • DOI: https://doi.org/10.1245/s10434-013-3442-3

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