Abstract
PurposeAnemia is common among patients with colorectal cancer and is associated with an increased risk of complications and poorer survival rate. The main objective of our study was to determine the effect of preoperative intravenous iron supplementation therapy on the need for red blood cell transfusions, other postoperative complications, and length of hospital stay in colon cancer patients undergoing colon resection.MethodsIn this retrospective cohort study, data were collected from medical records of all 549 colon carcinoma patients who underwent a colon resection in Helsinki University Hospital during the years 2017 and 2018. The patients were divided into two cohorts: one with anemic patients treated with preoperative intravenous iron supplementation therapy (180 patients) and one with anemic patients without preoperative intravenous iron supplementation therapy (138 patients). Non-anemic patients and patients requiring emergency surgery were excluded (231 patients).ResultsPatients treated with intravenous iron had less postoperative complications (33.9% vs. 45.9%, p = 0.045) and a lower prevalence of anemia at 1 month after surgery (38.7% vs. 65.3%, p < 0.01) when compared with patients without preoperative iv iron treatment. No difference was found in the amount of red blood cell transfusions, length of stay, or mortality between the groups.ConclusionThis is the first study demonstrating a significant decrease in postoperative complications in anemic colon cancer patients receiving preoperative intravenous iron supplementation therapy. This treatment also diminishes the rate of postoperative anemia, which is often associated with a facilitated recovery.
Highlights
Anemia is defined by the World Health Organization as having blood hemoglobin levels of less than 130 g/l in men and less than 120 g /l in non-pregnant women
We report no significant benefit from preoperative iv iron treatment compared to no iron in terms of red blood cell transfusions (RBCTs)-need in elective colon carcinoma patients with anemia
Calleja et al reported a significantly decreased number of postoperative RBCTs and number of patients with postoperative anemia at 30 days after surgery in a iv iron group. They hypothesized that iv iron reduces the number of postoperative complications indirectly by reducing the need for RBCTs [10]
Summary
Anemia is defined by the World Health Organization as having blood hemoglobin levels of less than 130 g/l in men and less than 120 g /l in non-pregnant women. Iron deficiency is Intravenous iron supplementation has been studied as a treatment method for iron-deficiency anemia among patients with colorectal cancer who are undergoing surgery. International Journal of Colorectal Disease (2022) 37:449–455 anemia [8] and more effective than oral iron at preventing postoperative anemia [9]. It has been associated with significantly lower amounts of allogeneic RBCT and a shorter length of stay (LOS). Some studies show conflicting evidence about the effect of iv iron on RBCT [2, 9,10,11,12,13]. According to a current consensus statement, iv iron “should be used as front-line therapy in patients who do not respond to oral iron or are not able to tolerate it, or if surgery is planned for < 6 weeks after the diagnosis of iron deficiency” [14]
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