Incidence Of Severe Postoperative Complications Research Articles

Impact of Preoperative Bevacizumab on Complications After Resection of Colorectal Liver Metastases: Case‐Matched Control Study

Chemotherapy may increase postoperative morbidity and mortality after liver surgery. Especially bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF), could have a detrimental effect. To assess the impact of neoadjuvant bevacizumab on clinical outcome after hepatectomy for colorectal liver metastases (CRLMs) this case-matched control study was initiated. The multicentric data collection was performed in the Swiss HPB Center of the University Hospital Zurich (CH), the Department of Digestive Surgery and Transplantation Strasbourg (F), and the Division of Hepato-biliary-pancreatic surgery of "Josep Tureta" Hospital Girona (E). Consecutive patients operated onbetween July 2005 and December 2007 due to CRLMs who received neoadjuvant chemotherapy were assessed. Patients were divided in two groups: group A had neoadjuvant chemotherapy with bevacicumab, and group B had it without bevacizumab. No differences in overall morbidity (56 vs. 40% in the bevacizumab and control groups, respectively, p = 0.23) or mortality could be documented. Similarly, the incidence of severe postoperative complications was not statistically different between the bevacizumab and control groups (31 and 18%, respectively, p = 0.31). Wound complications were comparable (11% in the bevacizumab group compared and 9% in the control group, p = 1.00). However, bevacizumab was associated with a significantly decreased incidence of postoperative hepatic insufficiency (7 vs. 20%, p = 0.03). No impact on the incidence or severity of complications by bevacizumab could be shown. Bevacizumab may even reduce the incidence of liver failure after liver surgery.

Spontaneous rupture of the oesophagus. Avoidance of postoperative morbidity.

Abstract Twelve cases of ‘spontaneous rupture’ of the oesophagus occurring over a period of 20 years (1951–71) are reviewed. The principal clinical and radiological features are described and the factors concerned in the pathogenesis of this condition are discussed. Although the mortality rate in this study was low (8 per cent) the incidence of severe post-operative complications was considerable, occurring in 10 of the 11 operative survivors. The importance of early diagnosis and adequate surgical treatment in the avoidance of this high morbidity is stressed.