A case of refractory pneumothorax during Bevacizumab-containing chemotherapy for multiple lung metastases from colon cancer

Abstract

The patient was a 64-year-old female, receiving bevacizumab-containing chemotherapy for the treatment of colon cancer with multiple lung metastases. She was referred to our hospital due to the recurrence of pneumothorax in spite of pleural drainage and pleurodesis. Computed tomography (CT) showed a fistula on the surface of the left lower lobe. Air leakage from the fistula was confirmed during surgery, and direct suture with coverage using polyglycolic acid felt and fibrin glue was performed. However, pneumothorax recurred after discharge. In the reoperation, air leakage was noted from the fistula, which had been closed during the first operation. A pedicled flap of serratus anterior muscle was harvested, and the fistula was covered with the flap. Pneumothorax did not recur after the reoperation. A retrospective review of the CT findings revealed that the subpleural tumor showed cavitation during chemotherapy and the pleural fistula formed with rupture of the cavity. The anti-angiogenetic effect of bevacizumab can be a cause of this refractory pneumothorax. Coverage with the pedicled flap was effective in this patient. We should have considered this method earlier.