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A Population-Based Study of Complications After Colorectal Surgery in Patients Who Have Received Bevacizumab

Baxter, Nancy, N., M.D., Ph.D., F.R.C.S.C.1–4; Fischer, Hadas, D., M.D., M.Sc.3; Richardson, Devon, P., M.D., M.Sc.2; Urbach, David, R., M.D., M.Sc., F.R.C.S.C.2–4; Bell, Chaim, M., M.D., Ph.D., F.R.C.P.C.3–6; Rochon, Paula, M.D., M.P.H., F.R.C.P.C.3,4,7; Brade, Anthony, M.D., Ph.D., C.M.8; Earle, Craig, C., M.D., M.Sc.3,6,9

Diseases of the Colon & Rectum: March 2018 - Volume 61 - Issue 3 - p 306–313
doi: 10.1097/DCR.0000000000000966
Original Contributions: Colorectal Cancer
Denotes Associated Video Abstract
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BACKGROUND: Patients receiving Bevacizumab, a vascular endothelial growth factor inhibitor used to treat metastatic colorectal cancer, may be at greater risk of complications after colorectal surgery because of impaired healing.

OBJECTIVE: The purpose of this study was to describe population-based rates of complications of colorectal surgery after Bevacizumab treatment and evaluate the relationship between time since last treatment and risk of complications.

DESIGN: This was a population-based retrospective cohort study using administrative and cancer registry data.

SETTINGS: The study was conducted in Ontario, Canada.

PATIENTS: Patients with metastatic colorectal cancer receiving Bevacizumab between January 2008 and December 2011 were followed for a year after treatment or until death.

MAIN OUTCOME MEASURES: Administrative data were used to identify patients who underwent colorectal surgery after initiation of Bevacizumab and to determine whether they experienced a complicated postoperative course. The relationship between time since last Bevacizumab treatment (≤28 d, 29 d to 3 mo, and >3 mo) and risk of postoperative complications was evaluated using logistic regression.

RESULTS: Of the 2759 patients who received Bevacizumab for the treatment of metastatic colorectal cancer, 265 underwent a colorectal procedure after exposure. The majority had a bowel resection or repair with no stoma (47.5%) and had emergency surgery (61.1%). Overall, 96 (36.2%) had a complicated postoperative course, including 20.4% readmission, 12.5% wound complications, and 7.9% mortality rate within 30 days of surgery. Adjusted multivariate analysis showed no difference in the likelihood of a complicated postoperative course among patients undergoing surgery within 28 days of receiving their last Bevacizumab dose compared with 29 days to 3 months (OR = 1.23 (95% CI, 0.53–2.84), or 3 to 12 months (OR = 0.98 (95% CI, 0.46–2.09) after receiving Bevacizumab.

LIMITATIONS: Reliance on administrative data to measure complications limited the scope of this study.

CONCLUSIONS: Patients with metastatic colorectal cancer requiring colorectal surgery after exposure to Bevacizumab experience substantial morbidity and mortality. The risk of complications is not detectably associated with time since exposure. See Video Abstract at

1 Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada

2 Department of Surgery, University of Toronto, Toronto, Ontario, Canada

3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

4 Institute of Health Policy, Management and Education, University of Toronto, Toronto, Ontario, Canada

5 Department of Medicine, Sinai Health System, Toronto, Ontario, Canada

6 Department of Medicine, University of Toronto, Toronto, Ontario, Canada

7 Women’s College Hospital, Toronto, Ontario, Canada

8 Trillium Health Partners, Mississauga, Ontario, Canada

9 Ontario Institute for Cancer Research, Toronto, Ontario, Canada

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (

Funding/Support: This study was conducted with support of the Ontario Institute for Cancer Research and Cancer Care Ontario through funding provided by the Government of Ontario and a Cancer Care Ontario Health Services Research Chair granted to Dr Baxter. This study was supported by the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care.

Financial Disclosure: None reported.

Correspondence: Nancy Baxter, M.D., Ph.D., Division of General Surgery, St. Michael’s Hospital, 040-16 Cardinal Carter Wing, 30 Bond St, Toronto, Ontario M5B 1W8, Canada. E-mail:

© 2018 The American Society of Colon and Rectal Surgeons