Does bevacizumab increase the risk of surgical complications for rectal cancer patients?

This study analyzed whether the drug bevacizumab is linked with increased rates of surgical complications.

In locally advanced rectal cancer the cancer has spread beyond the lining of the rectum or has spread to the nearby lymph nodes. The standard treatment for patients with locally advanced rectal cancer is radiochemotherapy followed by total mesorectal excision (TME). TME is a surgical procedure to remove the tumor and a large portion of bowel surrounding it.

Bevacizumab (Avastin) is an anti-cancer drug that inhibits the formation of new blood vessels needed for the cancer to grow and spread. Some recent studies have combined bevacizumab with preoperative radiochemotherapy and have suggested that it might benefit patients. However, whether bevacizumab leads to increased rates of surgical complications remains unclear.

Data from 62 patients with locally advanced rectal cancer were included in the study. Patients received radiotherapy (5 days per week), bevacizumab 5 mg/kg (on day 1, 15, and 29), capecitabine (Xeloda; days 1-14 and 22-35, 825 mg/m² twice daily), and oxaliplatin (Eloxatin; days 1, 8, 22, and 29, 50 mg/m²). Four to six weeks after radiochemotherapy the surgery was carried out.

The average duration of surgery was 239 minutes. The frequency of various complications was within the expected range. For 11% of patients at least one other organ needed to be removed during the surgery. 8% of patients had complications occur during the operation and 43% of patients had complications after the operation. The most common postoperative complications included wound infections and delayed wound healing (12.9% of patients).

There was no increased rate of postoperative bleedings in patients receiving bevacizumab (3% of patients) and the postoperative mortality rate was 0%.

The authors concluded that bevacizumab does not increase the operative complication rate compared to similar studies. They did not observe an increased rate of bleeding complications or postoperative complications.