Abstract
Introduction
Treatment guidelines for colorectal cancer (CRC) indicate that surgical intervention
within 4 weeks or 8 weeks after bevacizumab therapy might increase the risk of postoperative
complications and mortality, especially in patients who received emergent operation.
Therefore, we aimed to assess the association between different surgical timings,
emergent or elective surgery, and the risk of postoperative mortality.
Materials and methods
Using the Taiwan National Health Insurance Database and Taiwan Cancer Registry, we
identified patients with metastatic colorectal cancer (mCRC) who underwent surgery
within 1 year of receiving bevacizumab between January 2010 and December 2017. The
primary outcomes were 30-day, 60-day, and in-hospital mortality; the secondary outcomes
were hospital stay, 30-day readmission rate, and surgical complications. Multivariate
analysis was used to adjust for confounders.
Results
This study included 2,047 patients. In the multivariate analysis, patients who underwent
emergent operation and had higher Charlson scores had a significantly higher mortality
rate. Patients with a longer interval to surgery, more cycles of bevacizumab treatment,
and distal metastectomy had the opposite result. In subgroup analysis, patients who
received emergent operation within 28 days had the highest surgical mortality.
Conclusions
The interval to operation among mCRC patients who receive bevacizumab treatment should
exceed 4 weeks to avoid additional risk of mortality whether patients receiving elective
or emergent operation. Patients who received emergent operation within 28 days of
bevcizumab infusion had the highest risk of mortality.
Keywords
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References
- Global Cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.C.A. Cancer J. Clin. 2018; 68: 394-424https://doi.org/10.3322/caac.21492
- Colorectal cancer: metastases to a single organ.World J Gastroenterol. 2015; 21: 11767-11776https://doi.org/10.3748/wjg.v21.i41.11767
National Comprehensive Cancer Network; Cancer, C., 1.2021 version. https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf, (accessed 19 May 2021).
- Prognostic factors for recurrence after pulmonary resection of colorectal cancer metastases.Ann Thorac Surg. 2009; 87: 1684-1688https://doi.org/10.1016/j.athoracsur.2009.03.034
- Is primary tumour resection associated with survival improvement in patients with colorectal cancer and unresectable synchronous metastases? A pooled analysis of individual data from four randomised trials.Eur J Cancer. 2015; 51: 166-176https://doi.org/10.1016/j.ejca.2014.10.023
- Primary tumor resection for stage IV colorectal cancer in the era of targeted chemotherapy.J Gastrointest Surg. 2019; 23: 2144-2150https://doi.org/10.1007/s11605-018-4044-y
- Bevacizumab plus chemotherapy continued beyond first progression in patients with metastatic colorectal cancer previously treated with bevacizumab plus chemotherapy: ML18147 study KRAS subgroup findings.Ann Oncol. 2013; 24: 2342-2349https://doi.org/10.1093/annonc/mdt231
- Bevacizumab and wound-healing complications: mechanisms of action, clinical evidence, and management recommendations for the plastic surgeon.Ann Plast Surg. 2013; 71: 434-440https://doi.org/10.1097/SAP.0b013e31824e5e57
- Conversion surgery after cetuximab or bevacizumab plus FOLFIRI chemotherapy in colorectal cancer patients with liver- and/or lung-limited metastases.J Cancer Res Clin Oncol. 2020; 146: 2399-2410https://doi.org/10.1007/s00432-020-03233-7
- Surgical wound healing complications in metastatic colorectal cancer patients treated with bevacizumab.J Surg Oncol. 2005; 91: 173-180https://doi.org/10.1002/jso.20301
- Lack of evidence for increased operative morbidity after hepatectomy with perioperative use of bevacizumab: a matched case-control study.Ann Surg Oncol. 2007; 14: 759-765https://doi.org/10.1245/s10434-006-9074-0
- Preoperative bevacizumab does not significantly increase postoperative complication rates in patients undergoing hepatic surgery for colorectal cancer liver metastases.J Clin Oncol. 2008; 26: 5254-5260https://doi.org/10.1200/JCO.2008.17.7857
- Bevacizumab and postoperative wound complications in patients with liver metastases of colorectal cancer.Anticancer Res. 2015; 35: 2255-2261
- Perioperative complications after neoadjuvant chemotherapy with and without bevacizumab for colorectal liver metastases.J Gastrointest Surg. 2013; 17: 527-532https://doi.org/10.1007/s11605-012-2108-y
- Perioperative chemotherapy with or without bevacizumab in patients with metastatic colorectal cancer undergoing liver resection.Clin Colorectal Cancer. 2013; 12: 15-22https://doi.org/10.1016/j.clcc.2012.07.002
- Vascular endothelial growth factor targeted therapy in the perioperative setting: implications for patient care.Lancet Oncol. 2010; 11: 373-382https://doi.org/10.1016/S1470-2045(09)70341-9
- Colorectal cancer emergencies.J Gastrointest Cancer. 2013; 44: 132-142https://doi.org/10.1007/s12029-012-9468-0
- Emergency presentation of colon cancer is most frequent during summer.Colorectal Dis. 2011; 13: 663-668https://doi.org/10.1111/j.1463-1318.2010.02270.x
Bureau of National Health Insurance in Taiwan. The Drugs Payment Guideline for Anti-Neoplastic Agents. https://www.nhi.gov.tw/DL.aspx?sitessn=292&u=LzAwMS9VcGxvYWQvMjkyL3JlbGZpbGUvMC82MTM3L2NoYXA5XzExMDExLnBkZg%3d%3d&n=Y2hhcDlfMTEwMTEucGRm&ico%20=.pdf, (accessed 24 Dec 2020).
- http://nhird.nhri.org.tw/en/index.htm([Health and Welfare Data Science Center, Ministry of Health and Welfare, Taiwan])Date accessed: December 24, 2020
- Taiwan's national Health insurance research database: past and future.Clin Epidemiol. 2019; 11: 349-358https://doi.org/10.2147/CLEP.S196293
- Quality assessment and improvement of nationwide cancer registration system in Taiwan: a review.Jpn J Clin Oncol. 2015; 45: 291-296https://doi.org/10.1093/jjco/hyu211
- The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients.J Clin Epidemiol. 2008; 61: 1234-1240https://doi.org/10.1016/j.jclinepi.2008.01.006
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.J Clin Epidemiol. 1992; 45: 613-619https://doi.org/10.1016/0895-4356(92)90133-8
- Angiogenesis inhibition with bevacizumab and the surgical management of colorectal cancer.Br J Surg. 2006; 93: 1456-1463https://doi.org/10.1002/bjs.5624
- The role of vascular endothelial growth factor in wound healing.J Surg Res. 2009; 153: 347-358https://doi.org/10.1016/j.jss.2008.04.023
- Neoadjuvant bevacizumab persistently inactivates VEGF at the time of surgery despite preoperative cessation.Br J Cancer. 2012; 107: 961-966https://doi.org/10.1038/bjc.2012.342
- Phase I safety and pharmacokinetic study of recombinant human anti-vascular endothelial growth factor in patients with advanced cancer.J Clin Oncol. 2001; 19: 843-850https://doi.org/10.1200/JCO.2001.19.3.843
- Evaluation of the patients with colorectal cancer undergoing emergent curative surgery.SpringerPlus. 2016; 5: 2024https://doi.org/10.1186/s40064-016-3725-9
- Mortality following emergency laparotomy: a Swedish cohort study.BMC Surg. 2021; 21: 322https://doi.org/10.1186/s12893-021-01319-8
- A nationwide analysis of readmission rates after colorectal cancer surgery in the US in the Era of the Addordable Care Act.Am J Surg. 2020; 220: 1015-1022https://doi.org/10.1016/j.amjsurg.2020.04.013
- A population-based study of complications after colorectal surgery in patients who have received bevacizumab.Dis Colon Rectum. 2018; 61: 306-313https://doi.org/10.1097/DCR.0000000000000966
- Review: incidence and clinical significance of bevacizumab-related non-surgical and surgical serious adverse events in metastatic colorectal cancer.Eur J Surg Oncol. 2011; 37: 737-746https://doi.org/10.1016/j.ejso.2011.06.004
- Clinical outcomes associated with bevacizumab-containing treatment of metastatic colorectal cancer: the BRiTE observational cohort study.Oncol. 2009; 14: 862-870https://doi.org/10.1634/theoncologist.2009-0071
- Safety and efficacy of first-line bevacizumab with FOLFOX, XELOX, FOLFIRI and fluoropyrimidines in metastatic colorectal cancer: the BEAT study.Ann Oncol. 2009; 20: 1842-1847https://doi.org/10.1093/annonc/mdp233
- Impact of bevacizumab on functional recovery and histology of the liver after resection of colorectal metastases.Br J Surg. 2011; 98: 399-407https://doi.org/10.1002/bjs.7368
- A NSQIP review of major morbidity and mortality of synchronous liver resection for colorectal metastasis stratified by extent of liver resection and type of colorectal resection.J Gastrointest Surg. 2015; 19: 1982-1994https://doi.org/10.1007/s11605-015-2895-z
Article info
Publication history
Published online: October 01, 2022
Accepted:
September 28,
2022
Received in revised form:
August 5,
2022
Received:
April 19,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
