Iron therapy for the treatment of preoperative anaemia in patients with colorectal carcinoma: a systematic review

Borstlap, Wernard A. A.; Stellingwerf, M E; Moolla, Zaheer; Musters, Gijsbert D.; Buskens, C J; Tanis, Pieter J.; Bemelman, Willem A.

doi:10.1111/codi.13110

Cited by 29 publications

(21 citation statements)

References 30 publications

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“…330-1085) μg/l versus 27⋅5 (17-51⋅5) μg/l in oral group; P < 0⋅001), despite parity in recruitment ferritin levels (P = 0⋅224). This same relationship was evident with TSAT levels at surgery (median 19 (16-29) and 9 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14) per cent respectively; P < 0⋅001), despite TSAT levels being significantly lower in the intravenous group at recruitment (P = 0⋅039).…”

Section: Outcome Datasupporting

confidence: 58%

Randomized clinical trial of preoperative oral versus intravenous iron in anaemic patients with colorectal cancer

Keeler

Simpson

et al. 2017

British Journal of Surgery

140

194

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Section: Outcome Datasupporting

confidence: 58%

Randomized clinical trial of preoperative oral versus intravenous iron in anaemic patients with colorectal cancer

Keeler

Simpson

et al. 2017

British Journal of Surgery

140

194

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“…Second, no data was available on the preoperative iron supplementation of the patients. However, current available data do not provide conclusive evidence on preoperative iron supplements significantly affecting blood Hb in patients undergoing surgery for CRC 41 . Preoperative RT/CRT was considered another potential confounding factor but the Hb levels of the patients who received preoperative RT/CRT did not significantly differ from those of the other rectal cancer patients.…”

Section: Discussionmentioning

confidence: 93%

Preoperative anemia in colorectal cancer: relationships with tumor characteristics, systemic inflammation, and survival

Väyrynen

Tuomisto

Klintrup

et al. 2018

Sci Rep

107

100

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Anemia is common in colorectal cancer (CRC) but its relationships with tumor characteristics, systemic inflammation, and survival have not been well characterized. In this study, blood hemoglobin levels and erythrocyte mean corpuscular volume (MCV) levels were measured in two independent cohorts of 148 CRC patients and 208 CRC patients, and their correlation with patient and tumor characteristics, systemic inflammatory markers (modified Glasgow Prognostic Score: mGPS; serum levels of thirteen cytokines, C-reactive protein, albumin), and survival were analyzed. We found that anemia, most frequently normocytic, followed by microcytic, was present in 43% of the patients. Microcytic anemia was most commonly associated with proximal colon tumor location. Average MCV and blood hemoglobin levels were lower in tumors with high T-class. Low blood hemoglobin associated with systemic inflammation, including high mGPS and high serum levels of C-reactive protein and IL-8. Particularly, normocytic anemia associated with higher mGPS. Normocytic anemia associated with a tendency towards worse overall survival (multivariate hazard ratio 1.61, 95% confidence interval 1.07–2.42, p = 0.023; borderline statistical significance considering multiple hypothesis testing). In conclusion, anemia in CRC patients is most frequently normocytic. Proximal tumor location is associated with predominantly microcytic anemia and systemic inflammation is associated with normocytic anemia.

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“…Notwithstanding possible detrimental effects, iron in preoperative blood management to reverse the anaemia-associated prognosis has gained more attention [ 11 ]. In particular, this has led to the increased use of preoperative intravenous iron supplementation.…”

Section: Introductionmentioning

confidence: 99%

The role of preoperative iron deficiency in colorectal cancer patients: prevalence and treatment

Wilson

Dekker

Harlaar

et al. 2017

Int J Colorectal Dis

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BackgroundIn preoperative blood management of colorectal cancer patients, intravenous iron therapy is increasingly used to treat anaemia and prevent red blood cell transfusions. However, while iron deficiency is the most common cause of anaemia, little is known about the prevalence and namely type of iron deficiency in this population, whereas both types of iron deficiency (i.e. absolute and functional iron deficiency) are recommended to be treated differently by international cancer guidelines.ObjectiveThe aim of present study is to investigate the prevalence and namely type of iron deficiency in colorectal cancer patients, and to assess its clinical relevance.MethodsPreoperative iron status, clinical parameters (i.e. age, ASA classification, tumour location, tumour stage) and postoperative complications were retrospectively collected for all newly diagnosed colorectal cancer patients in our institution over a 3-year period.ResultsIron deficiency was observed in 163 (48.1%) of 339 patients. Of these iron-deficient patients, 3.7% had an isolated absolute iron deficiency (AID) and 15.3% a functional iron deficiency (FID), while the rest had a combination of AID and FID. Anaemia was present in 66.1% of iron-deficient patients. Iron deficiency was significantly associated with an increased postoperative complication rate (univariable OR 1.94, p = 0.03, multivariable OR 1.84, p = 0.07), with right-sided tumours (p < 0.001), high ASA classification (p = 0.002), advanced tumour stage (p = 0.01) and advanced age (p = 0.04). In comparing clinical parameters between patients with AID and FID, advanced age was significantly associated with FID (p = 0.03), and the presence of anaemia with AID (p = 0.02).ConclusionIn preoperative colorectal cancer patients, there is a high prevalence of iron deficiency, including a high percentage of patients with—a component of—functional iron deficiency, associated with the increased postoperative complication rate. As both types of iron deficiency require a different treatment strategy, our results illustrate the therapeutic potential of especially intravenous iron supplementation in patients with severe iron deficiency and stress the urgency of routinely monitoring preoperative iron status and differentiation between types of iron deficiency. As iron therapy may also be potentially harmful in respect to stimulation of tumour growth, future clinical trials assessing the long-term effect of iron therapy are necessary.

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Iron therapy for the treatment of preoperative anaemia in patients with colorectal carcinoma: a systematic review

Abstract: In anaemic patients who require surgery for colorectal carcinoma, current evidence is of inadequate quality to draw a definitive conclusion on the efficacy of the various measures to treat preoperative anaemia.

Cited by 29 publications

References 30 publications

Randomized clinical trial of preoperative oral versus intravenous iron in anaemic patients with colorectal cancer

Randomized clinical trial of preoperative oral versus intravenous iron in anaemic patients with colorectal cancer

Preoperative anemia in colorectal cancer: relationships with tumor characteristics, systemic inflammation, and survival

The role of preoperative iron deficiency in colorectal cancer patients: prevalence and treatment

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