Feasibility of surgery after systemic treatment with the humanized recombinant antibody bevacizumab in heavily pretreated patients with advanced epithelial ovarian cancer

Ann Surg Oncol. 2012 Apr;19(4):1326-33. doi: 10.1245/s10434-011-2134-0. Epub 2011 Nov 17.


Background: The aim of this study was to assess operative feasibility and outcome after bevacizumab treatment (BT) in ovarian cancer (OC) patients.

Patients and methods: We retrospectively identified all OC patients operated between April 2006 and September 2010 after BT.

Results: We identified 733 OC operations, 10 of which (1.36%) were performed in a mean time of 134 days (range, 10-288) after BT. Indication was secondary cytoreduction in 3 patients (mean days after BT, 181; range, 82-256) and palliation in 7 due to bowel obstruction and/or intestinal perforation or fistula (mean days after BT, 114; range, 10-288). All but 1 acutely operated patients developed a secondary wound healing, but none of the 3 patients after planned cytoreduction did. Of these 3 patients, 1 suddenly died on the 36th postoperative day, presumably of thromboembolism. None of the patients developed postoperatively a gastrointestinal morbidity; however, in 1 patient operated 21 days after BT due to a vesicointestinal fistula the bladder reconstruction could not heal and developed a permanent fistula.

Conclusions: Emergency surgery after BT due to bowel obstruction and/or fistulas seems to be associated with an impaired wound healing in advanced heavily pretreated platinum-resistant OC patients, while this does not appear the case in planned cytoreduction. Prospective evaluations are warranted to assess surgical safety after BT in this special patients' collective.

MeSH terms

  • Adult
  • Aged
  • Angiogenesis Inhibitors / adverse effects*
  • Antibodies, Monoclonal, Humanized / adverse effects*
  • Bevacizumab
  • Carcinoma, Ovarian Epithelial
  • Feasibility Studies
  • Female
  • Humans
  • Intestinal Obstruction / chemically induced*
  • Intestinal Obstruction / surgery*
  • Intestinal Perforation / chemically induced*
  • Intestinal Perforation / surgery*
  • Middle Aged
  • Neoplasm Staging
  • Neoplasms, Glandular and Epithelial / complications
  • Neoplasms, Glandular and Epithelial / drug therapy*
  • Neoplasms, Glandular and Epithelial / pathology
  • Ovarian Neoplasms / complications
  • Ovarian Neoplasms / drug therapy*
  • Ovarian Neoplasms / pathology
  • Palliative Care
  • Retrospective Studies
  • Treatment Outcome
  • Wound Healing


  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal, Humanized
  • Bevacizumab