Preoperative Bevacizumab Does Not Significantly Increase Postoperative Complication Rates in Patients Undergoing Hepatic Surgery for Colorectal Cancer Liver Metastases

2008 ◽  
Vol 26 (32) ◽  
pp. 5254-5260 ◽  
Author(s):  
Susan B. Kesmodel ◽  
Lee M. Ellis ◽  
E. Lin ◽  
George J. Chang ◽  
Eddie K. Abdalla ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
Serum Albumin ◽  
Liver Metastases ◽  
Wound Complications ◽  
Optimal Timing ◽  
Complication Rates ◽  
Lower Serum ◽  
Colorectal Cancer Liver Metastases ◽  
Increased Risk

Purpose Although bevacizumab (BV) increases survival rates when used with chemotherapy (CTX) in patients who have metastatic colorectal cancer (CRC), an increase in wound complications has been observed in patients who undergo surgery while receiving BV. We therefore evaluated whether neoadjuvant BV is associated with an increase in postoperative complications in patients undergoing surgery for CRC liver metastases. Patients and Methods Two subgroups of patients who received neoadjuvant CTX + BV (n = 81) or CTX alone (n = 44) were identified from a database of patients who underwent surgery for CRC liver metastases. Univariate and multivariate logistic regression models were used to evaluate the association of patient and tumor characteristics, neoadjuvant therapy, and operative factors with postoperative complications. Results Postoperative complications developed in 40 patients (49%) who received CTX + BV and 19 patients (43%) who received CTX. The median time from BV discontinuation to surgery was 58 days (range, 31 to 117 days). No significant associations were identified between BV use and timing of BV discontinuation and postoperative complications. On multivariate analysis, lower serum albumin and concomitant surgical procedures were associated with an increased risk of developing any complication (P = .035 and .023, respectively), and lower serum albumin was associated with hepatobiliary complications (P = .016). Conclusion Neither the use of BV nor timing of BV administration was associated with an increase in complication rates. These data suggest that the combination of BV with neoadjuvant CTX in patients who have CRC liver metastases does not increase surgical complications. To determine the optimal timing of surgery in patients receiving neoadjuvant BV, confirmatory prospective studies are required.

scholarly journals When can total knee arthroplasty be safely performed following prior arthroscopy?

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jin-Ning Ma ◽  
Xiao-Lin Li ◽  
Pan Liang ◽  
Sheng-Li Yu
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Complications ◽  
Knee Arthroplasty ◽  
Acl Injury ◽  
Control Group ◽  
Optimal Timing ◽  
Complication Rates ◽  
Increased Risk ◽  
Total Knee

Abstract Background The optimal timing to perform a total knee arthroplasty (TKA) after knee arthroscopy (KA) was controversial in the literature. We aimed to 1) explore the effect of prior KA on the subsequent TKA; 2) identify who were not suitable for TKA in patients with prior KA, and 3) determine the timing of TKA following prior KA. Methods We retrospectively reviewed 87 TKAs with prior KA and 174 controls using propensity score matching in our institution. The minimum follow-up was 2 years. Postoperative clinical outcomes were compared between groups. Kaplan-Meier curves were created with reoperation as an endpoint. Multivariate Cox proportional hazards regressions were performed to identify risk factors of severe complications in the KA group. The two-piecewise linear regression analysis was performed to examine the optimal timing of TKA following prior KA. Results The all-cause reoperation, revision, and complication rates of the KA group were significantly higher than those of the control group (p < 0.05). The survivorship of the KA group and control group was 92.0 and 99.4% at the 2-year follow-up (p = 0.002), respectively. Male (Hazards ratio [HR] = 3.2) and prior KA for anterior cruciate ligament (ACL) injury (HR = 4.4) were associated with postoperative complications in the KA group. There was a non-linear relationship between time from prior KA to TKA and postoperative complications with the turning point at 9.4 months. Conclusion Prior KA is associated with worse outcomes following subsequent TKA, especially male patients and those with prior KA for ACL injury. There is an increased risk of postoperative complications when TKA is performed within nine months of KA. Surgeons should keep these findings in mind when treating patients who are scheduled to undergo TKA with prior KA.

Safety of bevacizumab when given perioperatively for colorectal cancer with liver metastases: McGill University pilot study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15083-e15083
Author(s):  
P. Kavan ◽  
N. Bouganim ◽  
M. Eid ◽  
P. Metrakos ◽  
P. Chaudhury ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Pilot Study ◽  
Postoperative Complications ◽  
Cox Regression ◽  
Survival Rates ◽  
Optimal Timing ◽  
Complication Rates ◽  
Thromboembolic Events ◽  
Operative Complications ◽  
Post Operative Complications

e15083 Background: Bevacizumab (BV) increases responses and survival rates when used with chemotherapy in metastatic colorectal cancer (CRC). Current practice is to give peri-operative chemotherapy for resectable CRC liver metasases (LM). The safety and efficacy of chemo-BV in this setting is unknown. Post-operative complications have been reported in patients (pts) who underwent surgery while receiving BV. The goals were to determine safety of perioperative BV. Methods: In a prospective pilot study, patients with resectable LM from October 2005 to 2008 that received BV perioperatively along with chemotherapy. Of a total of 60 pts, 34 had oxaliplatin-based CTX, 22 CPT-11 (FOLFIRI) and 4 IROX. All but seven pts received BV pre and postoperatively. The average age was 55 years. All patients underwent liver surgery 6–8weeks post last dose of BV. Univariate Cox regression models were used to evaluate the association of patient and tumour characteristics, therapy and postoperative complications. Results: Postoperative complications developed in a total of 24 pts (40%). 12 pts (35%) who received Oxaliplatin CTX + BV, 9 pts (40%) with CPT 11 CTX + BV and 3 pts (75%) with Oxaliplatin + CPT-11 CTX +BV. The average time from BV discontinuation to surgery was 49 days. No significant associations were identified between BV and CTX regimen or timing and postoperative complications. Wound healing complication were most frequent with 8 pts (13%), DVT diagnosed in 6 pts (10%), protracted pancytopenia 4 pts (7%), sepsis 1pt, infections 2pts, MI 1pt, acute cardiomyopathy 1pt, and billiary leak 1pt. No bowel perforations or sudden deaths were reported. These side effects apart from thromboembolic events are comparable to previously reported post-operative complications. Conclusions: Neither the use of BV with CTX nor timing of BV administration were associated with a non acceptable increase in complication rates as compared to previously published by EORTC intergroup. Our data confirm that the combination of BV with neoadjuvant chemotherapy is feasible and safe in patients CRC LM. A higher incidence of thromboembolic events was seen. To determine the optimal timing and drug combination prospective randomized trials are urgently required. [Table: see text]

scholarly journals Chromosomal instability mediates immune exclusion and response to cytotoxic chemotherapy in colorectal liver metastases

2021 ◽  
Author(s):  
Carlos A Martinez ◽  
Liam F Spurr ◽  
Soumya C Iyer ◽  
Sian A Pugh ◽  
John A Bridgewater ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastases ◽  
Chromosomal Instability ◽  
Cellular Proliferation ◽  
Cytotoxic Chemotherapy ◽  
Curative Intent ◽  
Colorectal Cancer Liver Metastases ◽  
Cancer Pathogenesis ◽  
Increased Risk ◽  
Immune Exclusion

The genomic drivers of immune exclusion in colorectal cancer liver metastases (CRCLM) remain poorly understood. Chromosomal instability (CIN), resulting in aneuploidy and genomic rearrangements, is the central pathway of mismatch repair-proficient colorectal cancer pathogenesis; however, it is unknown whether CIN impacts the outcomes of patients with limited spread of CRCLM treated with curative intent cytotoxic chemotherapy and surgery. Herein, we examined the relationship between CIN and the molecular subtypes of CRCLM, immune signaling, treatment sensitivity, and patient outcomes in three independent CRCLM patient cohorts. We established that a previously developed 70-gene CIN signature (CIN70) is a reliable measure of CIN, encompassing features of both aneuploidy and cellular proliferation. We demonstrated that tumors with the canonical subtype of CRCLM exhibit elevated levels of CIN and aneuploidy. Genomically unstable tumors were associated with an immune-depleted tumor microenvironment, and patients with genomically unstable tumors were at increased risk for disease progression in adverse metastatic sites, resulting in poor progression-free and overall survival. However, high-CIN tumors were particularly susceptible to DNA-damaging chemotherapies, including topoisomerase inhibitors, as well as radiation therapy. Treatment with genotoxic agents depleted CIN-rich cell populations, which resulted in a concomitant increase in intratumoral CD8+ T-cells in patients with primary rectal, breast, and bladder cancer. Taken together, we propose a mechanistic explanation for why cytotoxic chemotherapy can augment anti-tumor immunity and improve outcomes in patients with genomically unstable cancers.

scholarly journals When can total knee arthroplasty be safely performed following prior arthroscopy?

2020 ◽  
Author(s):  
Jin-Ning Ma ◽  
Xiao-Lin Li ◽  
Pan Liang ◽  
Sheng-Li Yu
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Complications ◽  
Knee Arthroplasty ◽  
Acl Injury ◽  
Control Group ◽  
Optimal Timing ◽  
Complication Rates ◽  
Increased Risk ◽  
Total Knee

Abstract Background The optimal timing to perform a total knee arthroplasty (TKA) after knee arthroscopy (KA) was controversial in the literature. We aimed to 1) explore the effect of prior KA on the subsequent TKA; 2) identify who were not suitable for TKA in patients with prior KA, and 3) determine the timing of TKA following prior KA.Methods We retrospectively reviewed 87 TKAs with prior KA and 174 controls using propensity score matching in our institution. The minimum follow-up was two years. Postoperative clinical outcomes were compared between groups. Kaplan-Meier curves were created with reoperation as an endpoint. Multivariate Cox proportional hazards regressions were performed to identify risk factors of severe complications in the KA group. The two-piecewise linear regression analysis was performed to examine the optimal timing of TKA following prior KA.Results The all-cause reoperation, revision, and complication rates of the KA group were significantly higher than those of the control group (p<0.05). The survivorship of the KA group and control group was 92.0% and 99.4% at the 2-year follow-up (p=0.002), respectively. Male (Hazards ratio [HR]=3.2) and prior KA for anterior cruciate ligament (ACL) injury (HR=4.4) were associated with postoperative complications in the KA group. There was a non-linear relationship between time from prior KA to TKA and postoperative complications with the turning point at 9.4 months.Conclusion Prior KA is associated with worse outcomes following subsequent TKA, especially male patients and those with prior KA for ACL injury. There is an increased risk of postoperative complications when TKA is performed within nine months of KA. Surgeons should keep these findings in mind when treating patients who are scheduled to undergo TKA with prior KA.

Results of surgical treatment of colorectal cancer liver metastases in Latvia oncology center.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 485-485
Author(s):  
Armands Sivins ◽  
Lelde Lauka ◽  
Guntis Ancans ◽  
Sergejs Gerkis ◽  
Andrejs Pcolkins ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Postoperative Complications ◽  
Liver Metastases ◽  
Primary Tumor ◽  
Stage Iv ◽  
Colorectal Cancer Liver Metastases ◽  
Left Colon Cancer ◽  
Major Hepatectomies ◽  
Oncology Center

485 Background: Colorectal cancer (CRC) is the third leading cause of cancer death. At the time of diagnosis 25% of patients present with stage IV disease and out of all CRC patients 50% develop liver metastases. About 15% of them have initially resectable disease. Surgical resection is the best treatment option as it is associated with longer survival. Latvia Oncology center (LOC) provide expertise in managment of all cancers, including metastatic CRC. Methods: Data about CRC patients with surgicaly treated liver metastases was colected and analysed from Latvia Oncology center in period 2011-2014. This data is also included in LiverMetSurvey international registry of patients operated for CRC liver metastases. 66 patients underwent hepatectomies, 10 patients had 2 or more surgeries due to a reccurent disease. Results: 77 surgeries were performed, 31 were hemihepatectomies and 46 were limited resections. Sinchronous surgery for liver metastases and primary tumor were performed in 19 cases: 11 for left colon cancer, 6 for rigt colon cancer and 2 for rectal cancer. Initially resectable liver disease was found in 70 cases. Unilateral metastases were diagnosed in 61 cases while there were 17 cases of bilateral disease. Postoperative complications developed in 18 patients, 5 of those after sinchronous surgeries for primary tumor. In 10 cases complications developed after major anatomical right sided hemihepatectomy and in 8 cases after atypical resections. Most frequent hepatic complications were infected collection in hepatic loge (n=9), non infected collection (n=3) and biliary leak (n=3); all of those were successfully treated with percutaneous dreinage. 1 patient died due to a postoperative liver insufficiency after right sided hemihepatectomy for recurrent disease. Conclusions: Overall 77 hepatectomies were performed, mostly limited non anatomical resections. In majority of patients 1 or 2 metastases were diagnosed. Initally resectable were 89% of cases. Mass of postoperative complications developed after major hepatectomies, were liver related and successfully treated with minimally invasive procedures. Complication rate (16%) in LOC is comperable to other Europian centers.

scholarly journals Influence of comorbide pathology on the efficiency of laparoscopic operations in surgical treatment of patients with metastatic colorectal cancer

2018 ◽  
Vol 9 (4) ◽  
pp. 49-56
Author(s):  
V. E. Kolesnikov ◽  
D. V. Burcev
Keyword(s):  
Colorectal Cancer ◽  
Cardiovascular Risk ◽  
Surgical Treatment ◽  
Postoperative Complications ◽  
Metastatic Colorectal Cancer ◽  
Cardiovascular Complications ◽  
Wound Complications ◽  
Minor Trauma ◽  
Surgical Interventions ◽  
Increased Risk

Objective:to determine the effect of the initial comorbid burden in patients with metastatic colorectal cancer (CRC) and resectable liver metastases on the development of postoperative complications, depending on the use of laparoscopic or standard open operations.Materials and Methods:the study included 311 patients with verifed metastatic CRC T3-4N1-2M1 and resectable metastases in the liver. Depending on the organization of the surgical treatment, the patients were divided into two groups: the main group (n=161) performed laparoscopic surgical interventions and a control group (n=150) of patients with the same pathology who underwent traditional open operations. Te comorbidity was assessed by the Charlins comorbidity index, the risk of cardiovascular complications according to Goldman, the adjusted Lee index. Te effect of comorbidity on postoperative complications was studied by the method of constructing conjugacy tables.Results:in patients with metastatic RTC in class IV of the risk of cardiovascular complications according to Goldman and high cardiovascular risk in the Lee index, open surgical interventions had an advantage over laparoscopic surgery because of the risk of life-threatening cardiopulmonary pathology. In the I-III class of the risk of cardiovascular complications according to Goldman and low, as well as intermediate cardiovascular risk in Lee, the laparoscopic operations were not accompanied by an increased risk of postoperative cardiovascular complications and were accompanied, in addition to the traditional advantages of minor trauma, by reducing the complications associated with removal oncological drug, as well as infectious wound complications in the place of surgical intervention. Conclusion: when deciding whether to perform laparoscopic interventions in patients with metastatic CRC and resectable metastases in the liver, it is necessary to assess the comorbid load on the Goldman and Lee index before the operation.

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