Preoperative bevacizumab and volumetric recovery after resection of colorectal liver metastases.


BACKGROUND AND OBJECTIVES While preoperative treatment is frequently administered to CRLM patients, the impact of chemotherapy, with or without bevacizumab, on liver regeneration remains controversial. METHODS The early and late regeneration indexes were defined as the relative increase in liver volume (RLV) within 2 and 9 months from surgery. Regeneration rates of the preoperative treatment groups were compared. RESULTS Preoperative chemotherapy details and volumetric data were available for 185 patients; 78 (42.2%) received preoperative chemotherapy with bevacizumab (Bev+), 46 (24.8%) received chemotherapy only (Bev-), and 61 (33%) received no chemotherapy. Patients in the Bev+ and Bev- groups received similar chemotherapy cycles (4 [3-6] vs 4 [4-6]; P = 0.499). Despite the comparable clinicopathological characteristics and Resected Volume/Total Liver Volume (TLV) at surgery (P = 0.944) of both groups, Bev+ group had higher early and late regeneration (17.2% vs 4.3%; P = 0.035 and 14.0% vs 9.4%; P = 0.091, respectively). Of note, early and late regeneration rates (3.7% and 10.9% vs 6.6% and 5.5%, respectively) were comparable between the no chemotherapy and Bev- groups (all P > 0.05). In multivariable analysis -adjusted for gender, age, portal vein embolization, preoperative chemotherapy, resected liver volume, tumor number, postoperative chemotherapy, fibrosis, steatosis- bevacizumab independently predicted early liver regeneration (P = 0.019). CONCLUSION Our findings suggest that preoperative bevacizumab administered along with chemotherapy was associated with enhanced volumetric restoration. Interestingly, this effect was more pronounced among patients who received oxaliplatin-based regimens and bevacizumab compared to those treated with irinotecan-based regimens and bevacizumab.

DOI: 10.1002/jso.24769

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@article{Margonis2017PreoperativeBA, title={Preoperative bevacizumab and volumetric recovery after resection of colorectal liver metastases.}, author={Georgios Antonios Margonis and Stefan Buettner and Nikolaos Andreatos and Kazunari Sasaki and Manijeh Zargham Pour and Ammar Deshwar and Jane Wang and Mounes Aliyari Ghasebeh and Christos Damaskos and Neda Rezaee and Timothy M Pawlik and Christopher L. Wolfgang and Ihab R. Kamel and Matthew J. Weiss}, journal={Journal of surgical oncology}, year={2017} }