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- Title
Fistula complications of bevacizumab therapy in metastatic colorectal cancer – oncology surgeon’s point of view: a case presentation.
- Authors
Chițoran, Elena; Cirimbei, Ciprian; Simion, Laurențiu; Tănase, Bogdan; Ștefan, Daniela-Cristina; Luca, Dan Cristian; Rotaru, Vlad
- Abstract
Background. Bevacizumab therapy, indicated in the treatment of metastatic colorectal cancer, although associated with an increased overall survival, is frequently accompanied by certain complications that raise particular issues from a surgical point of view. Among these, gastrointestinal and complex colovaginal fistulas can raise severe problems in the surgical management of the case. Case presentation. A 43-year-old patient, diagnosed with lower rectal neoplasm, stage cT3N1M1PUL – stage IV (histopathological exam: ADK G2), followed, as a first stage of the multimodal treatment, 28 sessions of external radiotherapy associated with capecitabine. Under this treatment, numerical and dimensional progression of M1PUL was observed, therefore it was decided to continue chemotherapy in combination with bevacizumab. The subsequent evolution of M1PUL was favorable, the patient being referred to the surgery department where rectosigmoid resection was performed via the anterior route, followed by mechanical colorectal anastomosis and protective ileostomy. Despite the ileostomy, the patient developed an anastomotic fistula with a small flow which was treated conservatively until it was closed. After closing the ileostomy, due to the progression of M1PUL, it was decided to resume the therapy with the VEGF inhibitor, with the appearance of a complex colovaginal fistula, documented clinically and by imaging. Discussion. Its treatment involved the de facto definitive abolition of the mechanical colorectal anastomosis, in order to put the fistula to rest and allow for the reduction of local inflammation, with the subsequent resolution of the fistulous path. Conclusions. Although our case does not present rare complications of bevacizumab therapy, it highlights certain surgical problems that must be taken into consideration when initiating/resuming therapy. Although there are surgical solutions, in the case of our patient, the problem of permanent mutilation occurred in a young person. This raises the question of whether bevacizumab therapy should not be reconsidered in certain patients, considering that, in the absence of an overall survival benefit, the physical and mental discomfort that occurs as a result of the specific complications of this therapy may weigh more than the mental comfort given by the absence of neoplastic progression. Of course, this statement requires further studies that should evaluate the impact of these complications on patients.
- Subjects
METASTASIS; THERAPEUTIC complications; COLORECTAL cancer; FISTULA; SURGERY; VAGINAL fistula; RECTAL cancer
- Publication
Oncolog-Hematolog, 2022, Issue 61, p29
- ISSN
2066-8716
- Publication type
Article