A Review on Bevacizumab and Surgical Wound Healing An Important Warning to All Surgeons

Bevacizumab (Avastin, Genentech, Inc, San Francisco, CA), a humanized monoclonal antibody against vascular endothelial growth factor, was recently approved for the treatment of metastatic breast cancer. A PubMed and OVID search was performed using keywords: bevacizumab, Avastin; wound healing, VEGF, angiogenesis, and colorectal cancer. Our objective was to review the current literature in regard to bevacizumab and its adverse effects on surgical wound healing. Bevacizumab has been associated with multiple complications in regard to wound healing, such as dehiscence, ecchymosis, surgical site bleeding, and wound infection. Current literature suggests patients should wait at least 6 to 8 weeks (>40 days) after cessation to have surgery (half-life = 20 days). In addition, postoperative reinitiation of bevacizumab must wait >= 28 days to prevent an increased risk of wound healing complications, and the surgical incision should be fully healed. The adverse effects of bevacizumab in regard to wound healing must be considered in all surgical patients.