Bowel Perforation with Relevant Complications from Bevacizumab Plus FOLFIRI in the Treatment of Metastatic Colorectal Cancer

以Bevacizumab及FORFIRI治療轉移性大腸直腸癌導致之腸穿孔重大併發症

謝依蒨(Yi-Chien Hsieh) ； 蘇偉智(Wei-Chih Su) ； 張琮琨(Tsung-Kun Chang) ； 馬政仁(Cheng-Jen Ma) ； 蔡祥麟(Hsiang-Lin Tsai) ； 葉永松(Yung-Sung Yeh) ； 黃敬文(Ching-Wen Huang) ； 王照元(Jaw-Yuan Wang)

《中華民國大腸直腸外科醫學會雜誌》 29卷2期 (2018/06) Pp. 93-99

https://doi.org/10.6312/SCRSTW.201806_29(2).10630

摘要

Bevacizumab, a recombinant humanized monoclonal antibody blocks angiogenesis by inhibiting vascular endothelial growth factor (VEGF), is frequently using in treating metastatic colorectal cancer. Side effects of bowel perforation are relatively rare but fatal. This case series retrospectively reviewed the records of 213 patients with metastatic colorectal cancer receiving FOLFIRI with bevacizumab every two weeks in one single institute between Apr 2013 and Aug. 2017. Thirteen cases of bowel perforation among 213 mCRC (6.1%) patients associated with bevacizumab use were diagnosed. 8 of 13 (61.5%) patients presented with pneumoperitoneum, 2 (15.3%) with necrotizing fasciitis, 2 of 13 (15.3%) with enterocutaneous fistula and 1 (7.6%) with intra-abdominal abscess formation. Under broad-spectrum antibiotic administration with early intervention of stoma creation or intra-abdominal drainage, these thirteen patients all recovered uneventfully.

關鍵字

Bowel perforation ； Bevacizumab ； FOLFIRI ； Metastatic colorectal cancer

並列摘要

目的：Bevacizumab是一種血管內皮增生因子的單株抗體，經常用於治療轉移性大腸直腸癌的病人，其所造成之腸穿孔副作用發生率0.3~2.4%，雖罕見卻致命。本研究對其發生率、處理方式及相關預後做進一步討論。方法：以單一醫學中心，從2013年4月至2017年8月，總共收錄了213位接受bevacizumab + FORFIRI治療之轉移性大腸直腸癌病人。回顧性的記錄其腸穿孔發生之臨床特徵、處理方式和預後。結果：經過統計，共有13位病人(6.1%)發生腸穿孔之併發症，其中8位(61.5%)以氣腹表現，2位(15.3%)以壞死性筋膜炎表現，2位(15.3%)臨床表徵為腸皮廔管，1位(7.6%)以腹內膿瘍呈現。經過廣效性抗生素和即時手術處理，包含腸造口或腹內膿瘍引流以及清創手術，其中12位病人預後良好，只有一位病人因末期癌症肺部轉移死亡。統計結果顯示並無因bevacizumab治療產生之併發症所造成之死亡案例。結論：針對轉移性大腸直腸癌病人以bevacizumab治療所造成之腸穿孔併發症。臨床醫師須特別注意腸穿孔相關之臨床表徵，以廣效性抗生素及保守性手術治療可有效處理此併發症及避免致命之結果。

並列關鍵字

腸穿孔 ； Bevacizumab ； FOLFIRI ； 轉移性大腸直腸癌

參考文獻

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