Short course pre-operative ferrous sulphate supplementation – is it worthwhile in patients with colorectal cancer?

Abstract

Ann R Coll Surg Engl 2010; 92: 569-572 569Approximately 36,000 cases of colorectal cancer (CRC) are diagnosed per year in the UK.1 It is the third most common form of cancer among both males and females, and the second most common cause of cancer mortality in the UK. Preoperative anaemia is well recognised in patients presenting with colorectal cancer, with recent series suggesting a prevalence of iron deficiency in 60% 2 and an associated anaemia in up to 38% 3 of new presentations. Pre-operative anaemia is recognised as a predictive factor for blood transfusion, 4,5 as well as a predictor of adverse outcomes in surgical patients. Carson et al. 6 demonstrated that overall mortality increases as the haemoglobin concentration decreases, with even mild anaemia conferring an increased death risk.As well as becoming an increasingly scarce commodity, allogeneic blood transfusion confers potential risks to the recipient including immunomodulation, transfusion reaction and disease transmission. Peri-operative blood transfusion with allogeneic blood is also suggested to increase the risk of postoperative infectious complications. 7,8 A recent meta-analysis of 36 studies supports the evidence that perioperative blood transfusion has a detrimental effect on the recurrence of curable colorectal cancers although a direct causal relationship cannot be proven. 9While the benefits of long-term ferrous sulphate supplementation on iron-deficiency anaemia are well established, it is not known if short-course supplementation (2-3 weeks) impacts significantly on pre-operative haemoglobin levels

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

“…1. Seven studies were included in the review, of which three were RCTs [14][15][16] and four were cohort studies [17][18][19][20]. Of the latter, three were prospective and one retrospective.…”

Enhanced Recovery for Esophagectomy

“…Oral iron takes 2 weeks to increase serum hemoglobin levels and 2 months to normalize it. 54,55 The evidence for intravenous iron was contradictory between 2 RCTs. 52 No studies have assessed preoperative iron alone in esophagectomy; oral ferrous sulfate increased hemoglobin and reduced transfusion requirements in colorectal surgery in 1 RCT 53 and 2 nonrandomized studies.…”

Systematic Review and Meta-Analysis: What Is the Evidence for Oral Iron Supplementation in Treating Anaemia in Elderly People?

“…1). Nineteen studies were subsequently excluded as they compared different types of iron supplementation (N = 6) [15,[20][21][22][23][24], involved erythropoietin being simultaneously commenced (N = 3) [25][26][27], were observational studies only (N = 3) [7,28,29], compared groups with a mean age between 29 and 44 years [30,31], included non-anaemic participants (N = 2) [32,33], had no control or placebo group (N = 2) [34,35] or involved only participants between 40 and 55 years of age and no older people (N = 1) [36]. Therefore, only three studies were included in the full review ( Fig.…”