Background:The transfusion rate following colorectal cancer resection is between 10 and 30 per cent. Receipt of allogeneic blood is not without risk or cost. A preoperative adjunct that reduced the need for transfusion would mitigate these risks. This study was designed to determine whether iron sucrose reduces the likelihood of postoperative blood transfusion in patients undergoing elective colorectal cancer resection.
Methods:In this randomized prospective blinded placebo-controlled trial of patients undergoing resectional surgery with a preoperative diagnosis of colorectal cancer, 600 mg iron sucrose or placebo was given intravenously in two divided doses, at least 24 h apart, 14 days before surgery. The primary outcome measures were serum haemoglobin concentration, recorded at recruitment, immediately before surgery and at discharge, and perioperative blood transfusions.
Ann R Coll Surg Engl 2007; 89: 418-421 418Colorectal cancer is the third most common cancer in the UK. 1 Rates of peri-operative transfusion ranging from 20-75% have been reported in patients undergoing colorectal resection.
2,3Despite innovations in transfusion medicine, peri-operative transfusion of allogeneic blood components has inherent risks including immunomodulation, transmission of disease, allergic reaction, and allo-immunisation. More recently, the introduction of leukocyte-depleted blood has led to an increased cost pressure on health resources.Studies have shown that predictors of increased perioperative transfusion are proximal tumours, increasing tumour size, operative blood loss and pre-operative anaemia.
2,4,5Pre-operative anaemia is a frequent finding in this group of surgical patients and accounts for a substantial number of blood transfusions. Defining anaemia as a haemoglobin of less than 13.5 g/dl in men and 11.5 g/dl in women, locally recorded data from the preceding years' 223 surgical colorectal cancer patients demonstrated that 51% of men and 25% of women were anaemic (38% combined) on admission. The overall transfusion rate in the men and women was 28% and 41%, respectively, whereas in the anaemic patients it was 39% and 68%, respectively.The aim of this study was to assess whether pre-operative oral iron therapy would decrease pre-operative anaemia and, thereby, reduce the incidence of peri-operative transfusion.
Patients and MethodsThe study received approval from the Plymouth Healthcare Trust Local Research Ethics Committee.Patients diagnosed with colorectal cancer were identified in out-patient clinics. All patients fit for surgery were
SURGICAL ONCOLOGYAnn R Coll Surg Engl 2007; 89: 418-
This has implications for the design of regimes for liver cell gene therapy, allowing marked reduction of MOIs, and reducing both cost and risk of viral-mediated toxicity.
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