Yoshimoto Toshiaki, Yoshikawa Kozo, Higashijima Jun, Miyatani Tomohiko, Tokunaga Takuya, Nishi Masaaki, Takasu Chie, Kashihara Hideya, Takehara Yukako, Shimada Mitsuo
Department of Surgery Tokushima University Tokushima Japan.
Ann Gastroenterol Surg. 2020 Feb 12;4(2):151-155. doi: 10.1002/ags3.12312. eCollection 2020 Mar.
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.
(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.
(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.
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.
本研究旨在呈现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，并探讨贝伐单抗洗脱期后择期手术的安全性。
(a)我们回顾性调查了7例因贝伐单抗相关肠穿孔接受急诊手术的患者。(b)我们回顾性调查了2008年至2018年期间接受新辅助治疗后接受手术的104例晚期结直肠癌患者。
(a)在7例因胃肠道穿孔接受急诊手术的患者中，贝伐单抗给药和洗脱期的中位数分别为16周和24天。除不符合条件的患者外，所有患者均进行了造口术。2例患者发生术后腹腔脓肿，2例患者分别死于围手术期败血症和胃肠道出血；这2例患者的体能状态均较差。(b)在接受贝伐单抗治疗的患者(n = 45)和接受无贝伐单抗方案新辅助治疗的患者(n = 59)中，分别有31例和52例患者接受了放化疗。我们发现有无贝伐单抗与术后并发症均无相关性。
对于贝伐单抗给药继发胃肠道穿孔的患者，应谨慎考虑手术适应症。同时，在适当的停药时间后，贝伐单抗给药后进行择期手术是可行的。
