Abstract
Patients with metastatic colorectal cancer treated with bevacizumab from September 2007 to August 2012 were retrospectively reviewed. There were 228 patients treated, and seven gastrointestinal perforations treated in six patients (2.6%). Primary cancer resection was performed in three patients. The time to perforation from the first bevacizumab dose was 9-550 days (median 181). The time to operation from onset of symptoms was 6-244 hours (median 85). All patients had mild abdominal symptoms compared to patients with typical acute peritonitis. All were ambulatory at the time of admission, and diagnosed by computed tomography (CT) scan. Sites of perforation included three in the ileum, one in the appendix, one in the sigmoid colon, one in the rectum and one unknown. Pathological findings of the resected specimens were obtained from four patients, which showed a diverticulum, ulcer, chemotherapy-induced necrosis, and non-specific findings. No case of perforation at the primary tumor site was seen. There were no significant postoperative complications. Gastrointestinal perforation should be considered in patients treated with bevacizumab even if the abdominal symptoms are not severe. Surgical treatment is optimal for bevacizumab-related gastrointestinal perforation.
