A 58-year-old man has undergone anterior resection for a node-positive sigmoid cancer and now has three resectable bilateral colorectal liver metastases. He received neoadjuvant FOLFOX with bevacizumab, completing the last cycle three weeks ago. Regarding planned hepatectomy, which statement is correct?
- A Surgery should be deferred until at least six weeks after the last bevacizumab dose to reduce wound-healing complications ✓
- B Surgery should proceed now, as three weeks after bevacizumab is sufficient
- C Bevacizumab precludes any future hepatic resection
- D The presence of more than one metastasis makes resection contraindicated
Correct answer: A. Surgery should be deferred until at least six weeks after the last bevacizumab dose to reduce wound-healing complications
Explanation
Bevacizumab impairs angiogenesis and wound healing, and major hepatic resection should wait until at least six weeks after the last dose to reduce risks of impaired wound healing, bleeding, and anastomotic breakdown. Resection is appropriate whenever all disease can be cleared with an R0 margin and sufficient future liver remnant, regardless of lesion number or bilaterality, so neither the count nor prior bevacizumab is an absolute contraindication. Oxaliplatin-based regimens relate to sinusoidal injury, not the wound-healing concern here.
Reference: Sabiston Textbook of Surgery, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.