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Spontaneous colonic perforation (SCP) is a life-threatening complication of bevacizumab treatment, but data on its management is insufficient. We present five cases of SCP in patients who were receiving bevacizumab for extra-intestinal malignancies. Patients who underwent a partial colectomy at the perforation site (n=3) suffered from ongoing abdominal sepsis postoperatively and died within a month. In contrast, patients who underwent total colectomy (n=2) had a relatively prolonged survival and eventually died of primary disease progression. Considering the pathophysiology of bevacizumab-related SCP, a total colectomy can be a life-saving and definitive procedure when non-perforated segments of the colon appear unhealthy during intraoperative exploration.