{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:31:57Z","timestamp":1747182717427,"version":"3.40.5"},"reference-count":18,"publisher":"Wiley","issue":"29","license":[{"start":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T00:00:00Z","timestamp":1693785600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Thoracic Cancer"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Current NCCN guidelines for second\u2010line therapy in recurrent or metastatic esophago\u2010gastric cancers recommend the use of VEGF inhibitors such as ramucirumab. VEGF inhibitors have been shown to be associated with gastrointestinal perforation in clinical trials and late colorectal anastomotic leaks in a few case reports. Here, we present a case of late esophageal anastomotic leak in a patient receiving ramucirumab. Case information was obtained from our institution's electronic medical records. The patient was found to have T4N1M0, poorly differentiated invasive adenocarcinoma and subsequently received neoadjuvant chemoradiation followed by hybrid Ivor\u2010Lewis esophagectomy 6\u2009weeks later. He recovered well with no leak or perioperative complications. The patient had disease progression 9 months postoperatively on CT and PET imaging. Sixteen months after surgery he began paclitaxel and ramucirumab and 16\u2009weeks after ramucirumab initiation, he was found to have an esophago\u2010pulmonary fistula in the region of the anastomosis. Biopsies were negative for recurrence at the anastomosis. He died one week later from progressive pneumonia despite stenting. In conclusion, this is the only known report of delayed esophageal anastomotic complication associated with ramucirumab. VEGF inhibitor therapies such as bevacizumab have been associated with late (greater than 3 months postoperative) colorectal anastomotic complications including fistulas and leaks. Risk factors that have been associated are perioperative radiotherapy and history of early postoperative leak. These findings raise concern whether VEGF inhibitor therapy should be used in post\u2010esophagectomy patients with recurrence if these rare but catastrophic events are likely to be terminal.<\/jats:p>","DOI":"10.1111\/1759-7714.15084","type":"journal-article","created":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T04:20:45Z","timestamp":1693887645000},"page":"2976-2980","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Delayed esophageal anastomotic complication and ramucirumab therapy: A case report"],"prefix":"10.1111","volume":"14","author":[{"given":"Robert H.","family":"Roth","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Dartmouth\u2010Hitch Medical Center  Lebanon New Hampshire USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8820-1928","authenticated-orcid":false,"given":"Madison J.","family":"Malfitano","sequence":"additional","affiliation":[{"name":"Department of General Surgery Medstar Georgetown University Hospital  Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Reilley","sequence":"additional","affiliation":[{"name":"UVA Health, Division of Medical Oncology  Charlottesville Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7951-5677","authenticated-orcid":false,"given":"Linda W.","family":"Martin","sequence":"additional","affiliation":[{"name":"UVA Health, Division of Thoracic and Cardiovascular Surgery  Charlottesville Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,9,4]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Esophageal and Esophagogastric Junction Cancers.National Comprehensive Cancer Institute Clinical Guidelines. Version 4.2021."},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41392-020-00323-3"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1112088"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1179\/1973947815Y.0000000053"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61719-5"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(14)70420-6"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11845-017-1676-y"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.20938"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-006-9337-9"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1805101"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.21447"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2006.24.18_suppl.3534"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2009-0071"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00133.2005"},{"issue":"10","key":"e_1_2_8_16_1","first-page":"1293","article-title":"A case of perforation of the diverticulum of the appendix during chemotherapy with ramucirumab plus nab\u2010paclitaxel for gastric cancer","volume":"48","author":"Kurihara M","year":"2021","journal-title":"Gan To Kagaku Ryoho"},{"issue":"13","key":"e_1_2_8_17_1","first-page":"2240","article-title":"A case of gastrointestinal perforation in gastric cancer during chemotherapy with paclitaxel plus ramucirumab","volume":"46","author":"Tanaka T","year":"2019","journal-title":"Gan To Kagaku Ryoho"},{"issue":"13","key":"e_1_2_8_18_1","first-page":"2066","article-title":"A case of gastric cancer with ramucirumab\u2010related colon perforation after a subtotal colectomy","volume":"46","author":"Wada N","year":"2019","journal-title":"Gan To Kagaku Ryoho"},{"volume-title":"Package insert","year":"2014","author":"Cyramza","key":"e_1_2_8_19_1"}],"container-title":["Thoracic Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1759-7714.15084","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T23:31:22Z","timestamp":1697153482000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1759-7714.15084"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,4]]},"references-count":18,"journal-issue":{"issue":"29","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1111\/1759-7714.15084"],"URL":"https:\/\/doi.org\/10.1111\/1759-7714.15084","archive":["Portico"],"relation":{},"ISSN":["1759-7706","1759-7714"],"issn-type":[{"type":"print","value":"1759-7706"},{"type":"electronic","value":"1759-7714"}],"subject":[],"published":{"date-parts":[[2023,9,4]]},"assertion":[{"value":"2023-06-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-03","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-04","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}