Preoperative iron infusion can reduce the need for blood transfusions during colorectal surgery

Analysis of data from approximately six randomized controlled trials investigating the use of intravenous iron infusions before colorectal surgery suggests that the need for blood transfusions may be significantly reduced in these patients.

In a meta-analysis of five randomized trials in patients undergoing surgery for colorectal cancer, findings showed that the use of intravenous iron was associated with a 33% relative reduction in the risk of requiring a blood transfusion. I showed that I was doing it.¹

“With more than 20,000 large-scale colorectal cancer resections carried out in the UK each year, the findings from this study have the potential to improve outcomes for the second leading cause of cancer mortality.” said Toby Richards, MD, professor in the Department of Interventions. Faculty of Science, University College London.² “Until now, surgeons were uncertain whether the benefits of iron infusion could be realized during the short term of cancer treatment, resulting in limited uptake of this treatment. We show that improved outcomes can be achieved when iron infusion is performed in the period between diagnosis and surgery.”

The association between anemia and poor outcomes, including in patients undergoing surgery, is clear and well-documented. However, as Richards and his colleagues point out, some of the guidelines recommending this practice are based on retrospective, open-label studies. Citing the lack of large multicenter trials evaluating practice based on this guideline, researchers expand the current evidence base on the use of preoperative iron therapy in patients with colorectal cancer. The current research effort has begun. With this in mind, the researchers designed the research effort as a meta-analysis of randomized controlled trials on the topic from the MEDLINE, Emboss, and CENTRAL databases.¹

From these studies, researchers obtained data from 485 people, including 465 who underwent surgery. Of this cohort, 202 were female and 263 were male. Her five trials included in the meta-analysis used her three forms of intravenous iron infusion: ferrous sucrose, ferric carboxymaltose, and ferrous isomaltoside. The researchers noted that the median interval from intervention to surgery was 14 days in the intervention group and 19 days in the control group.¹

Analysis showed that a total of 78 patients in the 485-patient cohort required allogeneic transfusions, 12.7% in the intervention group and 19.5% in the control group (risk ratio). [RR] 0.67, 95% confidence interval [CI] 0.46～0.97, P=.04; risk difference [RD] -0.07, 95% CI, -0.12 to -0.02. P=.02). All five trials included in the study reported changes in hemoglobin levels.Among the 465 patients in these trials, intravenous iron intake was associated with an increase in absolute hemoglobin (Hedges’ g0.52, 95% CI, 0.08 to 0.96. P=.03).¹

Of the five included trials, four trials involving 423 patients reported 30- or 90-day, hospital, or all-cause mortality. In these trials, there was no difference in mortality between groups. The researchers looked at four trials that looked at the length of hospital stay in 405 patients. No differences between groups were observed in these trials. Additionally, no differences were observed between study groups in major postoperative complications.¹

“This analysis shows that blood transfusions are reduced by more than a third when anemic patients are treated with intravenous iron before colorectal surgery,” said Sue, MBChB, Vice-President of the British Society of Haematology. Pabor said.² “If we can combine this insight with other insights from the previous PREVENTT study, readmissions could be further reduced, which would be important for both patients and the NHS.”

References:

1. Lederhuber H, Massey LH, Abeysiri S, et al. Risks of preoperative intravenous iron and blood transfusions in colorectal cancer surgery: a meta-analysis of randomized clinical trials. Br J Sarg. Published online on November 23, 2023. doi:10.1093/bjs/znad320
2. University College London News. Injecting iron supplements before bowel surgery reduces the need for blood transfusions. Yurek Alert! November 22, 2023. Accessed December 1, 2023. https://www.eurekalert.org/news-releases/1008811.