Oct
2014

The feasibility and clinical efficacy of intravenous iron administration for preoperative anaemia in patients with colorectal cancer.

Keeler BD, Simpson JA, Ng S, et al.
Colorectal Dis 2014;16:794-800.
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Review by : B. Clevenger, T. Richards
NATA Review

In this pilot study, 20 anaemic patients undergoing surgery for colorectal cancer received intravenous (IV) ferric carboxymaltose preoperatively. Response to treatment was defined as a 1.5 g/dL increase in haemoglobin level from recruitment to the day of surgery. A statistically significant rise in haemoglobin concentration was demonstrated, with an average increase of 1.8 g/dL. Patients with higher erythropoietin levels and those with worse iron deficits showed a greater response.

The authors conclude that IV iron administration prior to colorectal surgery is feasible and results in a significant increase in haemoglobin level. Based on a predictive model, the authors propose that IV iron may reduce the need for perioperative blood transfusion, while rightly acknowledging limitations in a small study.

This pilot study shows that IV iron is effective to treat anaemia preoperatively and that, even in a colorectal cancer pathway where times can be short before surgery, preoperative anaemia management is feasible. Larger trials are now needed to assess the effect on patient welfare and to address whether optimising a patient before cancer surgery is a greater benefit when balanced against the small risk of short delay to surgery.

– Ben Clevenger and Toby Richards

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