Efficacy of protocol implementation based on intravenous iron treatment in gastrointestinal cancer surgery

Hernández, Cera C.; Cantero, Chloé; Rivas, F.; Martínez-Pallí, Graciela; Pereira, Anne Caroline Castro; Balust, Jaume

doi:10.1097/00003643-201106001-00042

Cited by 3 publications

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“…Stimulation of erythropoiesis to optimize preoperative Hb constitutes a fundamental pillar of multidisciplinary and multimodal “patient blood management” (PBM) programs, aimed at ensuring continuity of care and improving clinical outcome . However, in CRC patients, most published studies on the efficacy of preoperative anemia management with intravenous iron (IVI) for avoiding RBCT and improving outcome included few patients and/or their results were inconsistent (Appendix S1, available as supporting information in the online version of this paper) …”

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confidence: 99%

Preoperative management of colorectal cancer–induced iron deficiency anemia in clinical practice: data from a large observational cohort

et al. 2017

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BACKGROUND Preoperative anemia prevalence among colorectal cancer (CRC) patients is high and may adversely influence postoperative outcome. This study assesses the efficacy of a preoperative anemia managing protocol in CRC. STUDY DESIGN AND METHODS This was a retrospective analysis of consecutive CRC resections at two Spanish centers (January 2012 to December 2013). Preoperative anemia was defined as a hemoglobin (Hb) level of less than 13 g/dL and treated with intravenous iron (IVI) or standard care (oral iron or no iron). Red blood cell transfusion (RBCT) requirements was the primary outcome variable. Postoperative infection rate and length of hospital stay (LOS) were secondary outcome variables. Patients were managed with a restrictive transfusion trigger (Hb < 8 g/dL). Infection was diagnosed clinically and confirmed by laboratory, microbiologic, and/or radiologic evidence. RESULTS Overall, 322 of 571 patients (56%) presented with anemia: 232 received IVI and 90 standard care. There were differences in RBCT rate between no anemia and anemia (2% vs. 16%; p < 0.01), but not in postoperative infections (19% vs. 22%; p = NS) or LOS. Compared to those on standard care, anemic patients on IVI presented with lower Hb (10.8 g/dL vs. 12.0 g/dL; p < 0.001) at baseline, but similar Hb on day of surgery and Postoperative Day 30. There were no between‐group differences in RBCT rates (16% vs. 17%; p = NS), but infection rates were lower among IVI‐treated patients (18% vs. 29%; p < 0.05). No relevant IVI‐related side effects were recorded. CONCLUSION Compared to standard care, IVI was more effective in treating preoperative anemia in CRC patients and appeared to reduce infection rate, although it did not reduce postoperative RBCT.

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Preoperative management of colorectal cancer–induced iron deficiency anemia in clinical practice: data from a large observational cohort

et al. 2017

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“…Our study had set the objective to assess whether a therapy with a new‐generation IV iron preparation, such as FCM, could reduce the number of transfused RBC units in this patient setting. One of the suppositions of our study was that FCM is able to reduce RBC units requirements in patients with IDA who underwent surgery . Recently Quintana‐Diaz and colleagues reported the feasibility of a clinical protocol for management of subacute IDA anemia with FCM in a fast‐track anemia clinic: FCM was efficacious, safe, and well tolerated and could improve the use of blood products.…”

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confidence: 99%

Ferric carboxymaltose reduces the number of red blood cell units transfused and allows transfusion independence to be obtained in patients with iron deficiency anemia secondary to gastrointestinal chronic blood loss

et al. 2016

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Ferric carboxymaltose reduces transfusions and hospital stay in patients with colon cancer and anemia

Calleja

Delgado²,

Val³

et al. 2015

Int J Colorectal Dis

118

107

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PurposeThe purpose of the study was to evaluate the efficacy of preoperative intravenous (IV) ferric carboxymaltose (FCM) administration vs. no-IV iron in colon cancer (CC) anemic patients undergoing elective surgery with curative intention.MethodsThis was a multicenter, observational study including two cohorts of consecutive CC anemic patients: the no-IV iron treatment group was obtained retrospectively while FCM-treated patients were recorded prospectively.ResultsA total of 266 patients were included: 111 received FCM (median dose 1000 mg) and 155 were no-IV iron subjects. Both groups were similar in terms of demographic characteristics, tumor location, surgical approach, and intra-operative bleeding severity. The FCM group showed a significant lower need for red blood cell (RBC) transfusion during the study (9.9 vs. 38.7 %; OR: 5.9, p < 0.001). In spite of lower hemoglobin levels at baseline diagnosis and lower transfusion rates in the FCM group, the proportion of responders was significantly higher with respect to the no-IV group both at hospital admission (48.1 vs. 20.0 %, p < 0.0001) and at 30 days post-surgery (80.0 vs. 48.9 %, p < 0.0001). The percentage of patients with normalized hemoglobin levels was also higher in the FCM group (40.0 vs. 26.7 % at 30 days, p < 0.05). A lower number of reinterventions and post-surgery complications were seen in the FCM group (20.7 vs. 26.5 %; p = 0.311). The FCM group presented a significant shorter hospital stay (8.4 ± 6.8 vs. 10.9 ± 12.4 days to discharge; p < 0.001).ConclusionsPreoperative ferric carboxymaltose treatment in patients with CC and iron deficiency anemia significantly reduced RBC transfusion requirements and hospital length of stay, reaching higher response rates and percentages of normalized hemoglobin levels both at hospital admission and 30 days post-surgery.

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Efficacy of protocol implementation based on intravenous iron treatment in gastrointestinal cancer surgery

Cited by 3 publications

References 0 publications

Preoperative management of colorectal cancer–induced iron deficiency anemia in clinical practice: data from a large observational cohort

Preoperative management of colorectal cancer–induced iron deficiency anemia in clinical practice: data from a large observational cohort

Ferric carboxymaltose reduces the number of red blood cell units transfused and allows transfusion independence to be obtained in patients with iron deficiency anemia secondary to gastrointestinal chronic blood loss

Ferric carboxymaltose reduces transfusions and hospital stay in patients with colon cancer and anemia

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