[Surgical management of bevacizumab-associated XXXX due to perforation].

@entity1 @entity137 @entity1949 @entity5 @entity254 @entity1887 @entity532 @entity344 @entity298
INTRODUCTION: Bevacizumab (Avastin, Fa. Roche, Genentech) is the first anti-angiogenic agent to be approved for the routine clinical treatment of @entity5 . Its @entity137 profile is different to that of standard chemotherapeutic substances. Despite the rarity of gastrointestinal (GI) perforation in @entity1 treated with bevacizumab, this serious adverse event results in significant morbidity and mortality. It was the aim of this study, based on exemplary cases of the reporting clinic as well as on published experiences, to characterise the specific clinical findings, the extraordinary pathogenesis, and the therapeutic outcome of such cases of @entity298 caused by perforation after antibody treatment. METHODS: Data of all @entity1 with perforation-caused @entity298 due to bevacizumab therapy since its clinical inauguration were sought in i) the database of the reporting clinic (case series), ii) in the published literature for comparison (historical comparative group) and iii) analysed with regard to results of the surgical management (evaluated parameters: rate of @entity1949 of wound healing, morbidity, mortality). RESULTS: Over a time period of 4 years (from 2 / 1 / 2004 to 1 / 31 / 2008), overall 15 @entity1 were found in this study, among whom 4 @entity1 came from the reporting clinic (mean age, 57 years; males : females = 2 : 2). The mean duration of antibody (Ab) treatment until occurrence of the complication was 70 days (range: 8-150 days). Thirteen @entity1 underwent surgical intervention, 2 @entity1 died due to severe @entity298 without any operation. The overall morbidity was 73.3 % (n = 11 / 15), the mortality was 33.3 % (n = 5 / 15). All @entity1 with an @entity254 developed an @entity1887 (100 %). @entity532 occurred in 38.5 % of the subjects (n = 5 / 13). CONCLUSIONS: @entity298 after @entity344 due to bevacizumab-based Ab treatment needs to be considered as a rare but serious and life-threatening complication. Impairment of wound healing because of the inhibition of angiogenesis is the reason for a different management of @entity344 under these conditions compared with the standard surgical treatment of @entity298 of other causes. In particular, it is recommended to avoid primary @entity254 and to prefer application of an intestinal stoma.
