[Healing and targeted therapies: Management in perioperative period?]
G Pignot1, T Lebret, D Chekulaev
1Service d'urologie, hôpital Cochin, université René-Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France. gg_pignot@yahoo.fr
Introduction:
In the era of new-targeted therapies and neoadjuvant strategies, this article highlights the role of angiogenesis in the process of physiological wound healing with a review of literature about parietal complications under anti-angiogenic therapies.
Methods:
Research on Medline was carried out using the terms renal cell carcinoma, angiogenesis, wound healing, targeted therapies, and complications.
Results:
The frequency of these complications varies between 5 and 50% in recent series. These results depend on half-lives of each drug and perioperative management (before and after surgical procedure).
Conclusion:
In the absence of current recommendations, it is advised to stop bevacizumab at least five weeks before a surgical intervention and to take it back 4 weeks later. For the tyrosine kinase inhibitors, the treatment can be stopped 24-48 hours before the surgery and taken back 3-4 weeks later. Finally, for the mTOR inhibitors, it is advised to stop the treatment 7-10 days before and to take back it at least 3 weeks later.
Insights
Anti-angiogenic therapies can cause wound healing complications, occurring in 5-50% of patients. Specific drug discontinuation and resumption timelines are recommended to mitigate these risks during surgery.
Area of Science:
- Focuses on angiogenesis, a critical process in wound healing.
- Reviews literature on parietal complications associated with anti-angiogenic therapies.
Context:
- Discusses the increasing use of targeted therapies and neoadjuvant strategies.
- Highlights the role of angiogenesis in physiological wound healing.
- Examines parietal complications arising from anti-angiogenic treatments.
Purpose:
- To review the literature concerning parietal complications under anti-angiogenic therapies.
- To provide guidance on managing anti-angiogenic treatments around surgical procedures.
Summary:
- Anti-angiogenic therapies, used in treatments like renal cell carcinoma, can lead to wound healing complications with frequencies ranging from 5% to 50%.
- These complications are influenced by drug half-lives and perioperative management.
- Specific recommendations are provided for discontinuing and resuming bevacizumab, tyrosine kinase inhibitors, and mTOR inhibitors around surgical interventions.
Impact:
- Offers evidence-based recommendations for optimizing perioperative management in patients undergoing anti-angiogenic therapy.
- Aims to reduce the incidence and severity of wound healing complications.
- Informs clinical practice regarding the safe use of targeted therapies in surgical contexts.
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Peptic Ulcer Disease IV: Management
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current medication...
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:22Aneurysm IV: Nursing Management
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD: