Patients who had undergone liver resection between July 2004 and July 2008 at the McGill University Health Centre and who had received Bev in the perioperative period were identified through the hepatopancreatobiliary (HPB) database. All patients who received Bev kinase inhibitor Tofacitinib and underwent liver resection for CRLM were included. A total of 45 patients who had received Bev combined with cytotoxic chemotherapy were identified. Of these, 10 had received Bev only in the adjuvant setting for recurrent disease. The remaining 35 are the focus of this analysis. Basic demographic data, disease-specific data, information on the chemotherapy regimens administered, chemotherapy-related toxicities, perioperative data, imaging data, pathology reports and survival data were collected and reviewed.

Postoperative complications were reviewed and graded according to the Clavien classification system20 The primary objective of the study was to examine the effect of the addition of Bev on treatment-related toxicity and perioperative morbidity. Secondary outcomes included response to therapy as determined by Response Evaluation Criteria in Solid Tumours (RECIST) criteria21 and the effect of this therapy on overall patient survival. Although the actual chemotherapy regime to be used on a patient was decided at the discretion of the treating oncologist, the decision was guided by HBP Tumor Board recommendations. The strategy generally employed comprised 12 cycles of chemotherapy, of which six were administered preoperatively and six postoperatively. A break of 6�C8 weeks between the last dose of Bev and surgery was targeted.

Staged resections and portal vein embolization (PVE) were used liberally in this patient group. Response to treatment and resectability were assessed at a weekly multidisciplinary HPB Tumor Board meeting. All patients underwent full preoperative assessment including liver function tests and cross-sectional imaging with computed tomography (CT), magnetic resonance imaging (MRI) and CT-positron emission tomography (PET) as indicated. All CTs and CT-PETs were reviewed by a radiologist. A RECIST classification was used to assess treatment response. In addition, degree of liver steatohepatitis and fibrosis staging scores were reviewed on pathology specimens as per Kleiner et al.22 Finally, liver dysfunction was defined for every patient post-surgery intervention using the scoring system established by Schindl et al.

23 This scoring system is based on the peak bilirubin, international normalized ratio (INR), lactic acid and presence of encephalopathy, and has been correlated with clinical outcomes23 and measures of hepatic synthetic function Cilengitide (indocyanine green clearance).24 Data were analysed using spss 17.0 (SPSS, Inc., Chicago, IL, USA). stata 9.2 (StataCorp LP, College Station, TX, USA) was used for Kaplan�CMeier estimation of survival.