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Xiang JX, Nan YL, He J, Lopez-Aguiar AG, Poultsides G, Rocha F, Weber S, Fields R, Idrees K, Cho C, Maithel SK, Lv Y, Zhang XF, Pawlik TM. Preoperative anemia: impact on short- and long-term outcomes following curative-intent resection of gastroenteropancreatic neuroendocrine tumors. J Gastrointest Surg 2024; 28:852-859. [PMID: 38538480 DOI: 10.1016/j.gassur.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/10/2024] [Accepted: 03/09/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The effect of preoperative anemia on clinical outcomes of patients undergoing resection of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) has not been previously investigated. This study aimed to characterize how preoperative anemia affected short- and long-term outcomes of patients undergoing curative-intent resection of GEP-NETs. METHODS Patients who underwent curative-intent resection for GEP-NETs between January 1990 and December 2020 were identified from 8 major institutions. The last preoperative hemoglobin level was recorded; anemia was defined as <13.5 g/dL in males or <12.0 g/dL in females based on the guides of the American Society of Hematology. The effect of anemia on postoperative outcomes was assessed on uni- and multivariate analyses. RESULTS Among 1559 patients, the median age was 58 years (IQR, 48-66), and roughly one-half of the cohort was male (796 [51.1%]). Most patients had a pancreatic tumor (1040 [66.7%]), followed by small bowel (259 [16.6%]), duodenum (103 [6.6%]), stomach (66 [4.2%]), appendix (53 [3.4%]), and other locations (38 [2.6%]). The median preoperative hemoglobin level was 13.4 g/dL (IQR, 12.2-14.5). Overall, 101 (6.7%) and 119 (8.5%) patients received an intra- or postoperative packed red blood cell (pRBC) transfusion, respectively. A total of 972 patients (44.5%) experienced a postoperative complication. Although the overall incidence of complications was no different among patients who did (anemic: 48.7%) vs patients who did not (nonanemic: 47.3%) have anemia (P = .597), patients with preoperative anemia were more likely to develop a major (Clavien-Dindo grade ≥IIIa: 48.9% [anemic] vs 38.0% [nonanemic]; P = .006) and multiple (≥3 types of complications: 32.2% [anemic] vs 19.7% [anemic]; P < .001) complications. Of note, 1-, 3-, and 5-year overall survival (OS) rates were 96.7%, 90.5%, and 86.6%, respectively. On multivariable analysis, anemia (hazard ratio, 2.0; 95% CI, 1.2-3.2; P = .006) remained associated with worse OS; postoperative pRBC transfusion was associated with an OS (5-year OS: 75.0% vs 87.7%; P = .017) and recurrence-free survival (RFS; 5-year RFS: 66.9% vs 76.5%; P = .047). CONCLUSION Preoperative anemia was commonly identified in roughly 1 in 3 patients who underwent curative-intent resection for GEP-NETs. Preoperative anemia was strongly associated with a higher risk of postoperative morbidity and worse long-term outcomes.
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Affiliation(s)
- Jun-Xi Xiang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yang-Long Nan
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jin He
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Alexandra G Lopez-Aguiar
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, United States
| | - George Poultsides
- Department of Surgery, Stanford University, Palo Alto, California, United States
| | - Flavio Rocha
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington, United States
| | - Sharon Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Ryan Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, Wisconsin, United States
| | - Kamran Idrees
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, Tennessee, United States
| | - Cliff Cho
- Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, United States
| | - Yi Lv
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xu-Feng Zhang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States.
| | - Timothy M Pawlik
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States.
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Seng NWP, Barco JB, Wong MHL, Lim KX, Peh WM, Ng CT, Cushway T, Foo FJ, Koh FHX. Hypophosphatemia related to intravenous iron therapy with ferric carboxymaltose: A case series. Transfus Med 2023; 33:503-508. [PMID: 37263781 DOI: 10.1111/tme.12980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/28/2023] [Accepted: 04/13/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVES This case series would like to highlight hypophosphatemia related to ferric carboxymaltose and its adverse clinical consequences. BACKGROUND Intravenous iron supplementation is a good alternative to oral iron replacement in iron deficiency anaemia due to its ability to correct iron deficit with minimal infusions without incurring the gastrointestinal side effects of oral iron replacement. Ferric carboxymaltose is one common formula for intravenous iron supplementation. However, an increasingly recognised adverse side-effect of intravenous ferric carboxymaltose is hypophosphatemia. There has been increasing reports and studies highlighting hypophosphatemia related to intra-venous iron therapy. Though initially thought to be transient and asymptomatic, recent studies have shown that persistent hypophosphatemia in iron therapy can result in debilitating disease including myopathy, fractures and osteomalacia. METHODS A retrospective analysis of all patients who had ferric carboxymaltose was performed. RESULTS We highlight 3 cases where hyposphatemia affected the clinical outcomes. CONCLUSION With the increased use of IV iron it is important to be aware of the high potential for hypophosphatemia secondary to ferric carboxymaltose.
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Affiliation(s)
- Nigel Wei-Peng Seng
- Ministry of Health Holdings, Singapore, Singapore
- Sengkang General Hospital, Singapore, Singapore
| | | | | | | | | | | | - Tim Cushway
- The Iron Suites Medical Centre, Singapore, Singapore
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3
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Lynch CA. Are Patients Requiring Hartmann's Procedure Being Adequately Optimised for Surgery: An Audit Cycle. Cureus 2023; 15:e41589. [PMID: 37559850 PMCID: PMC10407682 DOI: 10.7759/cureus.41589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2023] [Indexed: 08/11/2023] Open
Abstract
Introduction Hartmann's procedures are common surgical operations indicated in a wide variety of presentations including colon malignancy, diverticular disease, volvulus, and colovesical and colovaginal fistulas. The procedure is a major undertaking for the patient and those presenting in the emergency setting are often clinically unwell with deranged laboratory investigations. Numerous studies have demonstrated that pre-operative anaemia contributes to increased morbidity and mortality. Applying the conclusions of one study recommending a minimum haemoglobin >12 g/dL level pre-operatively, this audit assessed patient optimisation prior to Hartmann's procedure. Materials and methods Patients undergoing Hartmann's procedures between May 2016 and February 2020 were identified. Data was collected retrospectively to analyse American Society of Anesthesiology (ASA) grade and pre-operative haemoglobin level. Pre-operative haemoglobin and group and save blood test values were identified pre-and post-intervention. Results Pre-intervention, 15 (21%) of 70 patients had a haemoglobin level <12 g/dL and 63 patients (90%) had a group and save blood test completed on admission. Post-intervention data was collected from 45 patients, with figures improving to five (11%) and 44 (97%) patients, respectively. Conclusion Our flowchart poster distribution and addition to the surgical proforma led to increased patient optimisation prior to Hartmann's procedure.
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Affiliation(s)
- Cameron A Lynch
- General Surgery, Tameside and Glossop Integrated Care National Health Service (NHS) Foundation Trust, Manchester, GBR
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4
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Deng Y, Weng M, Zhang J. Preoperative anemia and long-term survival in patients undergoing colorectal cancer surgery: a retrospective cohort study. World J Surg Oncol 2023; 21:122. [PMID: 37013545 PMCID: PMC10071685 DOI: 10.1186/s12957-023-03005-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 03/25/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The impact of preoperative anemia on a survival outcome and the importance of correcting preoperative anemia in patients with colorectal cancer (CRC) remain controversial. This study aimed to explore how preoperative anemia affects the long-term survival of patients undergoing colorectal cancer surgery. METHODS This was a retrospective cohort study in which adult patients underwent surgical resection for colorectal cancer between January 1, 2008, and December 31, 2014, at a large tertiary cancer center. A total of 7436 patients were enrolled in this study. Anemia was defined according to the diagnostic criteria of China (hemoglobin level < 110 g/L for women and < 120 g/L for men). The median follow-up time was 120.5 months (10.0 years). Inverse probability of treatment weighting (IPTW) using the propensity score was used to reduce selection bias. Overall survival (OS) and disease-free survival (DFS) were compared between patients with and without preoperative anemia using the Kaplan-Meier estimator and the weighted log-rank test based on IPTW. Univariate and multivariate Cox proportional hazards models were used to assess factors associated with OS and DFS. Multivariable Cox regression was also used to assess red blood cell (RBC) transfusion associations between preoperative anemia and outcomes. RESULTS After IPTW adjustment, clinical profiles were similar, except that tumor location and TNM stage remained imbalanced between the preoperative anemia and preoperative non-anemia groups (p < 0.001). IPTW analysis showed that the 5-year OS rate (71.3 vs. 78.6%, p < 0.001) and the 5-year DFS rate (63.9 vs. 70.9%, p < 0.001) were significantly lower in the preoperative anemia group. Multivariate analysis showed that preoperative anemia was associated with poorer OS and DFS, while RBC transfusion may improve OS (hazard ratio [HR] 0.54, p = 0.054) and DFS (HR 0.50, p = 0.020) in CRC patients with preoperative anemia. CONCLUSIONS Preoperative anemia is an independent risk factor for survival in patients undergoing colorectal surgery. Strategies to reduce preoperative anemia in patients with CRC should be considered.
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Affiliation(s)
- Yixu Deng
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui District, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Meilin Weng
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui District, Shanghai, 200032, People's Republic of China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
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5
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Chardalias L, Papaconstantinou I, Gklavas A, Politou M, Theodosopoulos T. Iron Deficiency Anemia in Colorectal Cancer Patients: Is Preoperative Intravenous Iron Infusion Indicated? A Narrative Review of the Literature. CANCER DIAGNOSIS & PROGNOSIS 2023; 3:163-168. [PMID: 36875314 PMCID: PMC9949551 DOI: 10.21873/cdp.10196] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/28/2022] [Indexed: 03/07/2023]
Abstract
Iron deficiency anemia is the most common extraintestinal symptom in patients with colorectal cancer (CRC). Inflammation associated with malignancy leads to functional iron deficiency via the hepcidin pathway, whereas chronic blood loss causes absolute iron deficiency and depletion of iron stores. The assessment and treatment of preoperative anemia is of great importance in patients with CRC, since published data have consistently shown that preoperative anemia is associated with increased need for perioperative blood transfusions and more postoperative complications. Recent studies have documented mixed results regarding the preoperative intravenous iron administration in anemic CRC patients in terms of efficacy for anemia correction, cost-effectiveness, need for transfusions and risk for postoperative complications.
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Affiliation(s)
- Leonidas Chardalias
- 2nd Surgical Department, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Papaconstantinou
- 2nd Surgical Department, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Gklavas
- 2nd Surgical Department, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Politou
- Hematology Laboratory - Blood Bank, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodosios Theodosopoulos
- 2nd Surgical Department, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
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6
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Miles LF, Pac Soo V, Braat S, Burgess A, Heritier S, Smart P, Tan N, Parker A, Burbury KL, Story DA. A protocol for a prospective, multicentre observational study to determine if nonanaemic iron deficiency worsens postoperative outcome in patients undergoing elective surgery for resection of colorectal cancer: The NATO study. Colorectal Dis 2023; 25:315-325. [PMID: 36238969 DOI: 10.1111/codi.16371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/25/2022] [Accepted: 09/29/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Preoperative absolute and functional iron deficiency anaemia is associated with poor postoperative outcomes in patients undergoing surgery for colorectal cancer. It is biologically plausible that "early", or "nonanaemic" iron deficiency may also be associated with worse postoperative outcomes in similar cohorts, albeit at lesser severity than that seen for anaemia. The evidence supporting this assertion is of low quality. METHODS We have designed a prospective, observational study to delineate associations between preoperative non-anaemic iron deficiency and postoperative outcomes after surgery for colorectal cancer. Patients without anaemia, undergoing elective surgery for colorectal cancer will be allocated to an iron replete or an iron deficient group based on preoperative transferrin saturation. The primary outcome is days alive and at home on postoperative day 90. Secondary outcomes include days alive and at home on postoperative day 30, length of hospital stay, readmission to acute care, postoperative complications, health-related quality of life scores, quality of postoperative recovery, and requirement for allogeneic blood transfusion. The planned sample size is 422 patients, which has 80% power to detect a two-day difference in the primary outcome. The study commenced in May 2019. CONCLUSION The results of this study will provide patients and clinicians with high-quality evidence concerning associations between nonanaemic iron deficiency and patient-centred outcomes after surgery for colorectal cancer. The study will be conducted in multiple urban and rural centres across Australia and New Zealand. The results will be highly generalisable to contemporary surgical practice and should be rapidly translated.
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Affiliation(s)
- Lachlan F Miles
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Department of Anaesthesia, Austin Health, Melbourne, Australia
| | - Vanessa Pac Soo
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,MISCH (Methods and Implementation Support for Clinical and Health) research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,MISCH (Methods and Implementation Support for Clinical and Health) research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Adele Burgess
- Department of Surgery, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Colorectal Surgical Unit, Austin Health, Melbourne, Australia
| | - Stephane Heritier
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Philip Smart
- Department of Surgery, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Colorectal Surgical Unit, Austin Health, Melbourne, Australia
| | - Nicole Tan
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Critical Care Institute, Epworth HealthCare, Melbourne, Australia
| | - Anna Parker
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Kate L Burbury
- Sir Peter MacCallum Department of Oncology, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - David A Story
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Department of Anaesthesia, Austin Health, Melbourne, Australia
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Abd-Elghany AA, Ahmed SM, Masoud MA, Atia T, Waggiallah HA, El-Sakhawy MA, Mohamad EA. Annona squamosa L. Extract-Loaded Niosome and Its Anti-Ehrlich Ascites’ Carcinoma Activity. ACS OMEGA 2022; 7:38436-38447. [DOI: 10.1021/acsomega.2c03649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/11/2022] [Indexed: 12/26/2022]
Affiliation(s)
- Amr A. Abd-Elghany
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdul-Aziz University, Al-Kharj11942, Saudi Arabia
- Biophysics Department, Faculty of Science, Cairo University, Giza12613, Egypt
| | - Samya Mahmoud Ahmed
- Department of Biochemistry, National Organization for Drug Control and Research (NODCAR), Egyptian Drug Authority (EDA), Giza12654, Egypt
| | - Marwa A. Masoud
- Department of Pharmacology, National Organization for Drug Control and Research (NODCAR), Egyptian Drug Authority (EDA), Giza12654, Egypt
| | - Tarek Atia
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdul-Aziz University, Al-Kharj11942, Saudi Arabia
| | - Hisham Ali Waggiallah
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdul-Aziz University, Al-Kharj11942, Saudi Arabia
| | - Mohamed A. El-Sakhawy
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdul-Aziz University, Al-Kharj11942, Saudi Arabia
- Department of Medicinal and Aromatic Plants, Desert Research Center, Cairo11753, Egypt
| | - Ebtesam A. Mohamad
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdul-Aziz University, Al-Kharj11942, Saudi Arabia
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8
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Hamaï A, Gong C, Mehrpour M. Editorial: The role of iron in cancer progression. Front Oncol 2022; 12:1026420. [PMID: 36212412 PMCID: PMC9534287 DOI: 10.3389/fonc.2022.1026420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ahmed Hamaï
- Inserm U1151, Institut Necker Enfants Malades, Faculté de Médecine, Team 5, Université Paris Cité, Paris, France
- FEROSTEM Group, Institut Necker Enfants Malades, Inserm U1151, Université Paris Cité, Paris, France
- *Correspondence: Ahmed Hamaï,
| | - Chang Gong
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Maryam Mehrpour
- Inserm U1151, Institut Necker Enfants Malades, Faculté de Médecine, Team 5, Université Paris Cité, Paris, France
- FEROSTEM Group, Institut Necker Enfants Malades, Inserm U1151, Université Paris Cité, Paris, France
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9
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Tomić Mahečić T, Brooks R, Noitz M, Sarmiento I, Baronica R, Meier J. The Limits of Acute Anemia. J Clin Med 2022; 11:jcm11185279. [PMID: 36142930 PMCID: PMC9505011 DOI: 10.3390/jcm11185279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 01/28/2023] Open
Abstract
For many years, physicians’ approach to the transfusion of allogeneic red blood cells (RBC) was not individualized. It was accepted that a hemoglobin concentration (Hb) of less than 10 g/dL was a general transfusion threshold and the majority of patients were transfused immediately. In recent years, there has been increasing evidence that even significantly lower hemoglobin concentrations can be survived in the short term without sequelae. This somehow contradicts the observation that moderate or mild anemia is associated with relevant long-term morbidity and mortality. To resolve this apparent contradiction, it must be recognized that we have to avoid acute anemia or treat it by alternative methods. The aim of this article is to describe the physiological limits of acute anemia, match these considerations with clinical realities, and then present “patient blood management” (PBM) as the therapeutic concept that can prevent both anemia and unnecessary transfusion of RBC concentrates in a clinical context, especially in Intensive Care Units (ICU). This treatment concept may prove to be the key to high-quality patient care in the ICU setting in the future.
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Affiliation(s)
- Tina Tomić Mahečić
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Center Zagreb—“Rebro”, 10000 Zagreb, Croatia
| | - Roxane Brooks
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH, Johannes Kepler University, 4040 Linz, Austria
| | - Matthias Noitz
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH, Johannes Kepler University, 4040 Linz, Austria
| | - Ignacio Sarmiento
- Department of Anesthesiology, Clinica Santa Maria, Santiago 7520378, Chile
| | - Robert Baronica
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Center Zagreb—“Rebro”, 10000 Zagreb, Croatia
| | - Jens Meier
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH, Johannes Kepler University, 4040 Linz, Austria
- Correspondence:
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10
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Kwon JH, Cho YH, Jang W, Kim SH, Ko HC, Ko WH, Kim YD. Effect of intraoperative intravenous ferric derisomaltose supplementation on reduction of postoperative anemia and transfusion in chronic kidney disease patients after total knee replacement. Medicine (Baltimore) 2022; 101:e30105. [PMID: 36107525 PMCID: PMC9439733 DOI: 10.1097/md.0000000000030274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Total knee replacement (TKR) is associated with a large amount of bleeding; therefore, the prevalence of postoperative anemia is high. In particular, patients with chronic kidney disease (CKD) are more vulnerable to postoperative anemia than are healthy individuals. Accordingly, the effect of intraoperative intravenous ferric derisomaltose (FDI) supplementation on postoperative anemia and blood transfusion volume reduction in patients with CKD was studied. Patients who underwent unilateral TKR between January 2019 and December 2020 were retrospectively reviewed. In analyzing the data, the patients fell into the CKD group (n = 85) and the non-CKD group (n = 106). Each group was divided into a group using FDI and a non-FDI group, and classified into 4 groups. The postoperative hemoglobin level for each postoperative day (POD) was determined as the primary outcome. In addition, the patient transfusion rate, volume of transfusion, and length of hospital stay were set as secondary study outcomes during the period from surgery to discharge. There was no statistically significant difference in hemoglobin levels on PODs 0, 1, 2, 7, and 14 in the CKD group. In the CKD group, the transfusion volume of the FDI group was 0.58 ± 0.91 units per person, which was statistically significantly lower than 1.28 ± 1.28 units of the non-FDI group (P = .01). In the CKD group, the transfusion rate of the FDI group was 30.2%, which was statistically significantly lower than that of the non-FDI group, which was 56.3% (P = .02). This study showed that intravenous FDI supplementation after TKR in CKD patients did not reduce postoperative anemia but was an effective and safe treatment to reduce transfusion volume and transfusion rate. There was no statistically significant difference in hemoglobin levels on POD 0, 1, 2, 7, and 14 in the non-CKD group. In the non-CKD group, the transfusion volume of the FDI group was 0.46 ± 0.88 units per person, which was lower than the 0.56 ± 0.91 units of the non-FDI group, but it was not statistically significant (P = .59). In the non-CKD group, the transfusion rate of the FDI group was 23.0%, which was lower than that of the non-FDI group, which was 31.3%, but it was not statistically significant (P = .37).
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Affiliation(s)
- Jae Hyun Kwon
- Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, South Korea
- *Correspondence: Jae Hyun Kwon, Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, 259 Wangsan-ro, Dongdaemun-gu, Seoul 02488, South Korea (e-mail: )
| | - Yong Hyun Cho
- Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, South Korea
| | - Won Jang
- Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, South Korea
| | - Sun Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, South Korea
| | - Hyun Cheol Ko
- Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, South Korea
| | - Woo Hyeong Ko
- Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, South Korea
| | - Young Do Kim
- Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, South Korea
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11
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Impact of preoperative anemia, iron-deficiency and inflammation on survival after colorectal surgery—A retrospective cohort study. PLoS One 2022; 17:e0269309. [PMID: 35895618 PMCID: PMC9328530 DOI: 10.1371/journal.pone.0269309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background Anemia is present in up to two-thirds of patients undergoing colorectal surgery mainly caused by iron deficiency and inflammation. As anemia is associated with increased risk of perioperative death, diagnosis and treatment of preoperative anemia according to etiology have been recommended. Objective The aim of the present study was to assess if the association between anemia and survival in patients undergoing colorectal surgery was determined by the severity of anemia alone or also by anemia etiology. Methods To determine the prevalence of anemia and etiology, preoperative hematological parameters, C-reactive protein, ferritin and transferrin saturation were retrospectively assessed and correlated with outcome in a cohort of patients undergoing colorectal surgery between 2005 and 2019 at the University Hospital of Innsbruck. Anemia was defined as hemoglobin <120 g/L in females and <130 g/L in males. The etiology of anemia was classified on the basis of serum iron parameters, as iron deficiency anemia, anemia of inflammation or other anemia etiologies. Results Preoperative anemia was present in 54% (1316/2458) of all patients. Anemia was associated with iron deficiency in 45% (134/299) and classified as anemia of inflammation in 32% (97/299) of patients with available serum iron parameters. The etiology of anemia was a strong and independent predictor of survival, where iron deficiency and anemia of inflammation were associated with better postoperative survival than other anemia etiologies. One year survival rates were 84.3%, 77.3% and 69.1% for patients with iron deficiency anemia, anemia of inflammation and other anemia types. Inflammation indicated by high C-reactive protein is a strong negative predictor of overall survival. Conclusions Anemia has a high prevalence among patients undergoing colorectal surgery and rational treatment requires early assessment of serum iron parameters and C-reactive protein.
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Lindholm S, Lindskogen S, Gamage B, Kurlberg G, Ljungman D. Measuring quality in colorectal cancer surgery in low- and middle-income countries: The Clavien-Dindo classification in a Sri Lankan cohort. Ann Med Surg (Lond) 2022; 79:104018. [PMID: 35860084 PMCID: PMC9289412 DOI: 10.1016/j.amsu.2022.104018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 02/07/2023] Open
Abstract
Background The colorectal cancer (CRC) incidence is increasing in low- and middle-income countries (LMICs) as part of an ongoing epidemiological transition. Surgery is the main treatment and surgical services are scaled up to meet the need. This warrants the establishment of frugal systems to measure safety and quality of surgical care that are tailored for low-resource settings. The aim of this study was to test the applicability of the Clavien-Dindo classification (CDC) for measurement of surgical complications in an LMIC setting where medical records are paper-based. Material and methods 88 patients who underwent CRC resection at Colombo South Teaching Hospital, Sri Lanka, from January 2017 to January 2020 were included. Medical records were retrospectively reviewed for postoperative complications and the severity was graded using the CDC. Results One or more postoperative complications (CDC ≥ grade II) occurred in 45.5% (n = 40) of the patients. The complications were distributed as grade II n = 46, grade III n = 3, grade IV n = 2 and grade V n = 0. The most common complication (22.7%, n = 20) was postoperative anemia treated with blood transfusion. The second most common complication was incisional surgical site infection (11.4%, n = 10). Conclusion Postoperative outcome could be evaluated by using the CDC in a Sri Lankan facility based on retrospective review of medical records. This suggests that the CDC is a feasible standardized system appropriate for measuring surgical quality also in other LMICs. Identified fields for possible quality improvement at the study site were to limit blood transfusions and minimize treatment with antibiotics. Global health is putting focus on not only access to surgery, but also surgical quality and safety. The Clavien-Dindo Classification may be a standardized way of evaluating surgical quality in low-resource settings. The feasibility of Clavien-Dindo Classification in a retrospective cohort in Sri Lanka is demonstrated.
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13
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van der Hulst HC, Dekker JWT, Bastiaannet E, van der Bol JM, van den Bos F, Hamaker ME, Schiphorst A, Sonneveld DJ, Schuijtemaker JS, de Jong RJ, Portielje JE, Souwer ET. Validation of the ACS NSQIP surgical risk calculator in older patients with colorectal cancer undergoing elective surgery. J Geriatr Oncol 2022; 13:788-795. [DOI: 10.1016/j.jgo.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/16/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
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14
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Risk Nomogram Does Not Predict Anastomotic Leakage After Colon Surgery Accurately: Results of the Multi-center LekCheck Study. J Gastrointest Surg 2022; 26:900-910. [PMID: 34997466 DOI: 10.1007/s11605-021-05119-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/10/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE Anastomotic leakage (AL) is a dreaded complication after colorectal surgery. Preoperatively identifying high-risk patients can help to reduce the incidence of this complication. For this reason, AL risk nomograms have been developed. The objective of this study was to test the AL risk nomogram developed by Frasson, et al. for validity and to identify risk-factors for AL. METHODS From the international multi-center LekCheck study database, patients who underwent colonic surgery with the formation of an anastomosis were included. Data were prospectively collected between 2016 and 2019 at 14 hospitals. Univariate and multivariable regression analyses, and area under receiver operating characteristic curve analysis (AUROC) were performed. RESULTS A total of 643 patients were included. The median age was 70 years and 51% were male. The majority underwent surgery for malignancies (80.7%). The overall AL rate was 9.2%. The risk nomogram was not predictive for AL in the population tested (AUROC 0.572). Low preoperative haemoglobin (p = 0.006), intraoperative hypothermia (p = 0.02), contamination of the operative field (p = 0.004), and use of epidural analgesia (p = 0.02) were independent risk-factors for AL. CONCLUSION The AL risk nomogram could not be validated using the international LekCheck study database. In the future, intraoperative predictive factors for AL, as identified in this study, should also be included in AL risk predictors.
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15
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Kuang XH, Li J. Dilemma in selection of treatment for preoperative anemia in patients with gastric cancer. Shijie Huaren Xiaohua Zazhi 2022; 30:92-99. [DOI: 10.11569/wcjd.v30.i2.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
One of the common comorbidities of patients with gastric cancer waiting for gastrectomy is anemia, which negatively affects the postoperative outcomes and prognosis. Therefore, preoperative anemia often needs to be corrected. The most commonly used strategy to treat preoperative anemia in gastric cancer is transfusion. Currently, a large amount of evidence shows that transfusion can increase the incidence of postoperative complications and affect the long-term survival of patients. Therefore, there is a dilemma in choosing the treatment for preoperative anemia in patients with gastric cancer. Surgeons need to fully understand the duality of therapy strategies for preoperative anemia in gastric cancer patients. In this study, we review the studies on preoperative anemia and its treatment in patients with gastric cancer, aiming to help clinicians manage patients undergoing gastrectomy for cancer better.
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16
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Tang G, Zhang L, Huang W, Wei Z. Iron Supplementation Effectively Ameliorates Anemia and Reduces the Need for Blood Transfusion in Patients Undergoing Colorectal Cancer Surgery: A Meta-Analysis. Nutr Cancer 2021; 74:2303-2312. [PMID: 34890292 DOI: 10.1080/01635581.2021.2014900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Anemia is common and harmful in patients undergoing colorectal cancer (CRC) surgery. Blood transfusion (BT) is used to treat anemia, but results in a poor oncology prognosis. Iron supplementation may be effective in improving anemia and reducing the need for BT, however, the results remain controversial. This meta-analysis was conducted to evaluate the efficacy of iron supplementation in improving hemoglobin concentrations (Hb) and reducing the need for BT. METHODS Up to February 10, 2021, PubMed, Web of Science, Cochrane Library, Embase databases were searched for studies evaluating the effects of iron supplementation on CRC surgery patients. Meta-analysis was conduct using the random-effects model. RESULTS Seven trials with 879 participants in total were included in the meta-analysis. The pooled findings suggested that iron supplementation effectively increased Hb (MD 0.41; 95% CI: 0.12, 0.69, P = 0.006) and reduced the risk of BT (RR 0.60, 95% CI 0.45, 0.78, P = 0.0002) compared with the control group. In addition, subgroup analyses showed that these benefits were observed with both oral and intravenous iron supplementation. CONCLUSION Iron supplementation is effective in ameliorating anemia and reducing the need for BT in CRC surgery patients.
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Affiliation(s)
- Gang Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Linyu Zhang
- Department of Clinical Medicine, Chongqing Medical University, Chongqing, China
| | - Wang Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengqiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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17
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Cosialls E, El Hage R, Dos Santos L, Gong C, Mehrpour M, Hamaï A. Ferroptosis: Cancer Stem Cells Rely on Iron until "to Die for" It. Cells 2021; 10:cells10112981. [PMID: 34831207 PMCID: PMC8616391 DOI: 10.3390/cells10112981] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 12/13/2022] Open
Abstract
Cancer stem cells (CSCs) are a distinct subpopulation of tumor cells with stem cell-like features. Able to initiate and sustain tumor growth and mostly resistant to anti-cancer therapies, they are thought responsible for tumor recurrence and metastasis. Recent accumulated evidence supports that iron metabolism with the recent discovery of ferroptosis constitutes a promising new lead in the field of anti-CSC therapeutic strategies. Indeed, iron uptake, efflux, storage and regulation pathways are all over-engaged in the tumor microenvironment suggesting that the reprogramming of iron metabolism is a crucial occurrence in tumor cell survival. In particular, recent studies have highlighted the importance of iron metabolism in the maintenance of CSCs. Furthermore, the high concentration of iron found in CSCs, as compared to non-CSCs, underlines their iron addiction. In line with this, if iron is an essential macronutrient that is nevertheless highly reactive, it represents their Achilles’ heel by inducing ferroptosis cell death and therefore providing opportunities to target CSCs. In this review, we first summarize our current understanding of iron metabolism and its regulation in CSCs. Then, we provide an overview of the current knowledge of ferroptosis and discuss the role of autophagy in the (regulation of) ferroptotic pathways. Finally, we discuss the potential therapeutic strategies that could be used for inducing ferroptosis in CSCs to treat cancer.
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Affiliation(s)
- Emma Cosialls
- Institut Necker-Enfants Malades (INEM), Inserm U1151-CNRS UMR 8253, Université Paris Descartes-Sorbonne Paris Cité, F-75993 Paris, France; (E.C.); (R.E.H.); (L.D.S.)
| | - Rima El Hage
- Institut Necker-Enfants Malades (INEM), Inserm U1151-CNRS UMR 8253, Université Paris Descartes-Sorbonne Paris Cité, F-75993 Paris, France; (E.C.); (R.E.H.); (L.D.S.)
| | - Leïla Dos Santos
- Institut Necker-Enfants Malades (INEM), Inserm U1151-CNRS UMR 8253, Université Paris Descartes-Sorbonne Paris Cité, F-75993 Paris, France; (E.C.); (R.E.H.); (L.D.S.)
| | - Chang Gong
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Guangzhou 510120, China;
| | - Maryam Mehrpour
- Institut Necker-Enfants Malades (INEM), Inserm U1151-CNRS UMR 8253, Université Paris Descartes-Sorbonne Paris Cité, F-75993 Paris, France; (E.C.); (R.E.H.); (L.D.S.)
- Correspondence: (M.M.); (A.H.)
| | - Ahmed Hamaï
- Institut Necker-Enfants Malades (INEM), Inserm U1151-CNRS UMR 8253, Université Paris Descartes-Sorbonne Paris Cité, F-75993 Paris, France; (E.C.); (R.E.H.); (L.D.S.)
- Correspondence: (M.M.); (A.H.)
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18
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Mukherjee S, Ghosh S, Choudhury S, Gupta P, Adhikary A, Chattopadhyay S. Pomegranate Polyphenols Attenuate Inflammation and Hepatic Damage in Tumor-Bearing Mice: Crucial Role of NF-κB and the Nrf2/GSH Axis. J Nutr Biochem 2021; 97:108812. [PMID: 34224820 DOI: 10.1016/j.jnutbio.2021.108812] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/12/2021] [Accepted: 06/13/2021] [Indexed: 12/27/2022]
Abstract
It has been widely reported that cancer, along with its treatment regimens, cause severe toxicity in the host. A suitable agent having chemopreventive properties as well as capabilities of ameliorating tumor- and drug-induced toxicities is of imminent need. Pomegranate has been projected as an excellent anti-tumor, anti-inflammatory and anti-oxidant agent. In this study, for the first time, we delineated the exact signaling cascade by which dietary supplementation of pomegranate fruit extract (PFE) protects tumor-bearing mice from tumor-induced hepatotoxicity. Increased activities of serum Alanine transaminase, Aspartate transaminase, Lactate dehydrogenase and Alkaline phosphatase, as well as histological studies confirmed the establishment of a state of hepatic dysfunction in tumor-bearers. Further investigations revealed that increased hepatic reactive oxygen species content and glutathione depletion-initiated apoptosis in these hepatocytes as we observed an alteration in the apoptotic proteins. PFE supplementation in tumor-bearing mice, on the other hand, differentially modulated redox-sensitive transcription factors Nrf2 and NF-κB, ultimately decreasing tumor-induced hepatic oxidative damage and cell death. siRNA-mediated inhibition of Nrf2 and NF-κB completely abolished the hepato-protective activities of PFE while pre-treatment of tumor-conditioned hepatocytes with N-acetyl cysteine augmented the cyto-protective properties of PFE. The present study clearly identified Nrf2/NF-κB/glutathione axis as the key factor behind the hepatoprotective potential of PFE. These findings would add to the existing knowledge about cancer chemoprevention by dietary polyphenols and might lead to the application of pomegranate polyphenols as supplement to escalate the effectiveness of cancer therapy by protecting normal cells from cancer related toxicities.
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Affiliation(s)
| | - Sayan Ghosh
- Department of Physiology, University of Calcutta; Kolkata, India
| | | | - Payal Gupta
- Department of Physiology, University of Calcutta; Kolkata, India
| | - Arghya Adhikary
- Centre for Research in Nanoscience and Nanotechnology, University of Calcutta, Kolkata, India
| | - Sreya Chattopadhyay
- Department of Physiology, University of Calcutta; Kolkata, India; Centre for Research in Nanoscience and Nanotechnology, University of Calcutta, Kolkata, India.
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19
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Bojesen RD, Eriksen JR, Vogelsang RP, Grube C, Forman JL, Gogenür I. The dynamic effects of preoperative intravenous iron in anaemic patients undergoing surgery for colorectal cancer. Colorectal Dis 2021; 23:2550-2558. [PMID: 34166572 DOI: 10.1111/codi.15789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/02/2021] [Accepted: 06/18/2021] [Indexed: 12/21/2022]
Abstract
AIM The aim of this study was to describe the dynamic changes in blood work following individual adjusted dosage of intravenously administered iron(III) isomaltoside in a 4-week period prior to surgery in patients with colorectal cancer. METHODS This was a single-centre, observational cohort study with prospectively collected data, including patients with colorectal cancer receiving preoperative treatment with iron(III) isomaltoside. Blood samples were taken at baseline, 1 week, 2 weeks and 4 weeks after initial treatment. Sixty-two patients were included in the study. RESULTS Sixty-two patients were included for final analysis. The mean increase in haemoglobin was 0.77 g/dl (95% CI 0.52-1.03 g/dl, P < 0.0001) at week 1, 1.5 g/dl (95% CI 1.21-1.80 g/dl, P < 0.0001) at week 2 and 2.13 g/dl (95% CI 1.71-2.55 g/dl, P < 0.0001) at week 4. Patients with severe anaemia (<9.02 g/dl) showed the largest increase in haemoglobin during the treatment course (2.92 g/dl, 95% CI 2.27-3.58 g/dl, P < 0.0001). Patients with mild anaemia (>10.31 g/dl) did not show a significant increase (0.66 g/dl, 95% CI -0.29-1.61 g/dl, P = 0.17). The mean of transferrin saturation after 4 weeks was 8% (95% CI 6%-10%, P < 0.0001). CONCLUSIONS After intravenously administered iron, patients with severe anaemia had the most substantial increase in haemoglobin, and the increase was largest after 4 weeks. Patients with mild anaemia did not have an increase in haemoglobin during the treatment course. The vast majority of patients still had iron deficiency at surgery 4 weeks after the initial treatment.
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Affiliation(s)
- Rasmus Dahlin Bojesen
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark.,Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
| | | | | | - Camilla Grube
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark.,Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ismail Gogenür
- Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
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20
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Jocić M, Arsenijević N, Gajović N, Jurišević M, Jovanović I, Jovanović M, Zdravković N, Marić V, Jovanović M. Anemia of inflammation in patients with colorectal cancer: Correlation with Interleukin-1, Interleukin-33 and Galectin-1. J Med Biochem 2021; 41:79-90. [PMID: 35611243 PMCID: PMC9069245 DOI: 10.5937/jomb0-30135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 07/11/2021] [Indexed: 12/24/2022] Open
Abstract
Background Patients with colorectal cancer (CRC) have anemia often present as a consequence of chronic bleeding from tumor. The exact role of lL-33, Galectin-l and IL-l in the pathological genesis of anemia in colorectal cancer patients has not been elucidated yet. The main goal of this research was to analyze Gal-l, IL-l and lL-33 systemic values in anemic and non-anemic CRC patients. Methods Concentrations of IL-33, Galectin-1 and IL-1 have been studied in blood samples of 55 CRC patients (27 without anemia and 28 with anemia). Results CRC patients with anemia had more severe and local advanced disease compared to CRC non-anemic patients. Anemia positively correlated with higher nuclear grade, lymph and blood vessel invasion, as well as with higher TNM stage, detectable metastatic lesions in lung and liver and peritoneal carcinomatosis. Significantly higher IL-33, Gal-1 and IL-1 concentration have been found in sera of patients with CRC and detected anemia. CRC patients mostly had microcytic anemia, while ferritin values were in normal range. Analysis revealed positive mutual correlation between serum values of galectin-1, IL-1 and IL-33 in CRC patients. Level of hemoglobin negatively correlated with serum IL-33, Gal-1 and IL-1. We have analyzed the Receiver Operating Characteristic (ROC) curves of serum IL-33, Gal-1 and IL-1 showed that these cytokines can be treated as additional markers for anemia of inflammation in CRC patients. Conclusions Predomination of Galectin-1, IL-1 and IL-33 in anemic CRC patients implicates on their potential role in anemia genesis and further development.
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Affiliation(s)
- Miodrag Jocić
- Military Medical Academy, Institute for Transfusiology and Haemobiology
| | - Nebojša Arsenijević
- University of Kragujevac, Faculty of Medical Sciences, Center for Molecular Medicine and Stem Cell Research
| | - Nevena Gajović
- University of Kragujevac, Faculty of Medical Sciences, Center for Molecular Medicine and Stem Cell Research
| | - Milena Jurišević
- University of Kragujevac, Faculty of Medical Sciences, Department of Clinical Pharmacy
| | - Ivan Jovanović
- University of Kragujevac, Faculty of Medical Sciences, Center for Molecular Medicine and Stem Cell Research
| | | | - Nataša Zdravković
- University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine
| | - Veljko Marić
- University of East Sarajevo, Faculty of Medicine Foca, Department of Surgery, Bosnia and Herzegovina
| | - Marina Jovanović
- University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine
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21
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Post-operative Anemia After Major Surgery: a Brief Review. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2021. [DOI: 10.1007/s40138-021-00232-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Abstract
Purpose of Review
Anemia is a very common complication in the post-operative period. Post-operative anemia is associated with poor outcomes including but not limited to infections, increased length of stay, circulatory overload, and mortality. The strategy of patient blood management focuses on three pillars that include the detection and treatment of pre-operative anemia; reduction of peri-operative blood loss; and harnessing and optimizing the patient-specific physiological reserve of anemia.
Recent Findings
Multiple studies in surgical patients have been conducted to study various methods of management of post-operative anemia. Recent advances in surgical techniques have also been studied to minimize blood loss. There is a widespread consensus on the use of intravenous iron in hospitalized post-operative patients after major surgery.
Summary
We discuss the most common causes of post-operative anemia and management focusing on measures to reduce blood loss and measures to increase red blood cell (RBC) mass. In this brief review, we present updates from the most relevant articles in the past 5 years and include updates from the 2018 international consensus statement on the management of post-operative anemia after major surgical procedures.
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22
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Abstract
Excessive gut luminal iron contributes to the initiation and progression of colorectal cancer. However, emerging evidence suggests that reduced iron intake and low systemic iron levels are also associated with the pathogenesis of colorectal cancer. This is important because patients with colorectal cancer often present with iron deficiency. Iron is necessary for appropriate immunological functions; hence, iron deficiency may hinder cancer immunosurveillance and potentially modify the tumor immune microenvironment, both of which may assist cancer development. This is supported by studies showing that patients with colorectal cancer with iron deficiency have inferior outcomes and reduced response to therapy. Here, we provide an overview of the immunological consequences of iron deficiency and suggest ensuring adequate iron therapy to limit these outcomes.
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Affiliation(s)
- Oliver Phipps
- O. Phipps, M.J. Brookes, and H.O. Al-Hassi are with the Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Matthew J Brookes
- O. Phipps, M.J. Brookes, and H.O. Al-Hassi are with the Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, United Kingdom.,Royal Wolverhampton Hospitals NHS Trust, Gastroenterology Unit Wolverhampton, Wolverhampton, United Kingdom
| | - Hafid O Al-Hassi
- O. Phipps, M.J. Brookes, and H.O. Al-Hassi are with the Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, United Kingdom
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23
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Ploug M, Kroijer R, Qvist N, Lindahl CH, Knudsen T. Iron deficiency in colorectal cancer patients: a cohort study on prevalence and associations. Colorectal Dis 2021; 23:853-859. [PMID: 33253490 DOI: 10.1111/codi.15467] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/14/2020] [Accepted: 11/14/2020] [Indexed: 12/15/2022]
Abstract
AIM The aim of this work was to estimate the prevalence of iron deficiency in patients diagnosed with colorectal cancer (CRC) and to clarify its association with patient- and tumour-related characteristics. METHOD This was a single-centre registry-based cohort study. Iron status was routinely evaluated upon diagnosis of CRC, and these data were coupled with patient- and tumour-specific data from the Danish CRC Group Registry (2013-2018). Data were analysed using multivariate logistic regression. RESULTS Out of 846 patients, 543 (64%) were iron deficient. There was an association between increasing depth of invasion and iron deficiency, with odds ratios (ORs) of iron deficiency being 2.8 (p = 0.001, CI 1.5-5.1), 4.22 (p < 0.001, CI 2.48-7.18) and 4.63 (p < 0.001, CI 2.30-9.34) for T-stages 2, 3 and 4, respectively. Right-sided tumours had an OR of 3.54 (p < 0.001, CI 2.22-5.67) of iron deficiency compared with left-sided tumours. Tumours diagnosed through the national CRC screening programme were less likely to be associated with iron deficiency (OR 0.34, CI 0.22-0.52), while female gender was associated with an increase in the odds for iron deficiency (OR 1.91, CI 1.33-2.76). Iron deficiency was prevalent in 88% of anaemic patients and 43% of nonanaemic patients. CONCLUSION Iron deficiency was highly prevalent in patients diagnosed with CRC. Increased depth of tumour invasion, right-sided location and female gender were all associated with higher odds for iron deficiency, while patients diagnosed through the national screening programme were associated with lower odds for iron deficiency. A large proportion of patients with a normal haemoglobin were also iron deficient.
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Affiliation(s)
- Magnus Ploug
- Department of Surgical Gastroenterology, Hospital of South West Jutland, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Rasmus Kroijer
- Department of Surgical Gastroenterology, Hospital of South West Jutland, Esbjerg, Denmark
| | - Niels Qvist
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Charlotte Hass Lindahl
- Department of Surgical Gastroenterology, Hospital of South West Jutland, Esbjerg, Denmark
| | - Torben Knudsen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Medical Gastroenterology, Hospital of South West Jutland, Esbjerg, Denmark
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24
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Ionescu A, Sharma A, Kundnani NR, Mihăilescu A, David VL, Bedreag O, Săndesc D, Dinu AR, Săndesc MA, Albulescu N, Drăgoi RG. Intravenous iron infusion as an alternative to minimize blood transfusion in peri-operative patients. Sci Rep 2020; 10:18403. [PMID: 33110237 PMCID: PMC7591902 DOI: 10.1038/s41598-020-75535-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/14/2020] [Indexed: 01/07/2023] Open
Abstract
Despite the reported benefits of intravenous iron therapy (IVIT) for correcting iron deficiency anemia (IDA) before any major surgery and the evidence thereof, perioperative allogenic blood transfusion (ABT) practice is still considered as the only viable option by some clinicians worldwide. As ABT increases the likelihood of infections, cardiac complications, longer hospital stays and mortality among the patients, the practice of ABT should only be reserved for critical cases (Hb level < 7 g/dl). Timely iron studies and iron replenishment (oral/IV) of prospective surgical patients could help decrease the ABT practice, and prove beneficial from both the clinical and economic standpoint. Evidence based patient blood management guidelines should be developed and standardized for use by clinicians worldwide. These guidelines should include specific instructions on timely assessment of surgical patients for correction of their IDA by either oral iron supplementation, if time permits, or by using IVIT such as ferric carboxymaltose (FCM) in emergency surgeries and in patients with functional ID. This study was conducted to explore the clinical benefits of the timely administration of IV-FCM in iron-deficient preoperative patients during 2017-2018 and compare the results thereof with that of the ABT. Based on the IDA treatment plan of 2953 patients, 11.14% cases were administered IV FCM (Group 1), 11.58% cases received ABT (Group 2), while the remaining 77.27% of anemic cases received neither ABT nor IV FCM (Group 3). The results indicate that the IV FCM administration reduces the need for ABT and thus minimizes its associated side effects. The findings of our study concur with the favorable outcomes reported by the other similar studies.
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Affiliation(s)
- Alin Ionescu
- Department of Family Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Abhinav Sharma
- Department of Cardio-Vascular Rehabilitation & Family Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Nilima Rajpal Kundnani
- Department of Physiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
| | - Alexandra Mihăilescu
- Department of Genetics, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Vlad Laurențiu David
- Department of Pediatric Surgery and Orthopedics, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Ovidiu Bedreag
- Department of Anesthesia and Intensive Care, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Dorel Săndesc
- Department of Anesthesia and Intensive Care, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Anca Raluca Dinu
- Department of Physical Medicine and Balneology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Mihai Alexandru Săndesc
- Department of Orthopedics and Traumatology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Nicolae Albulescu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Răzvan Gabriel Drăgoi
- Department of Rehabilitation Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
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25
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Janssen TL, Steyerberg EW, van Gammeren AJ, Ho GH, Gobardhan PD, van der Laan L. Intravenous Iron in a Prehabilitation Program for Older Surgical Patients: Prospective Cohort Study. J Surg Res 2020; 257:32-41. [PMID: 32818782 DOI: 10.1016/j.jss.2020.07.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Older patients often have iron deficiency anemia before surgery, which can be effectively treated with intravenous iron supplementation (IVIS). Anemia and blood transfusions are associated with an increased risk of delirium. The aim of this research was to assess the effectiveness and safety of using IVIS in a prehabilitation program. MATERIAL AND METHODS Patients ≥70 y who underwent abdominal surgery between November 2015 and June 2018 were included in this single-center prospective cohort study. All patients were prehabilitated; however, only anemic patients received a single dose of 1000 mg intravenous iron (ferric carboxymaltose) to increase preoperative hemoglobin levels (IVIS group). Nonanemic patients received standard care (SC). The hemoglobin levels (primary outcome) were assessed at the outpatient clinic visit, at admission, and at discharge. Secondary outcomes were postoperative delirium, postoperative anemia, blood transfusion, complications other than delirium, and length of hospital stay. All outcomes were compared between the IVIS group and SC group. RESULTS Of all patients (n = 248), 97 anemic patients received IVIS (39%). Of the anemic patients, 50 patients (52%) had iron deficiency. Initial differences in hemoglobin concentrations between the IVIS group and SC group at T1 and T2 (7.2 versus 8.8; P < 0.001 and 7.4 versus 8.6; P = 0.023, respectively) were no longer present at discharge (6.6 versus 7.2; P = 0.35). No statistically significant differences were observed for all secondary outcomes between the IVIS group and the SC group. No infusion-related adverse events occurred. CONCLUSIONS Adding IVIS to prehabilitation programs is safe and diminishes differences in these concentrations between preoperatively anemic and nonanemic patients. IVIS may be worthwhile as an additional component of prehabilitation programs. Results merit further investigation.
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Affiliation(s)
- Ties L Janssen
- Department of Surgery, Amphia Hospital, Breda, the Netherlands.
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Adriaan J van Gammeren
- Department of Clinical Chemistry and Haematology, Amphia Hospital, Breda, the Netherlands
| | - Gwan H Ho
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | | | - Lijckle van der Laan
- Department of Surgery, Amphia Hospital, Breda, the Netherlands; Department of Cardiovascular Science, University Hospital Leuven, Belgium
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26
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Yeap E, Teoh WMK, Nguyen TC, Suhardja TS. Preoperative anaemia and thrombocytopenia are associated with venous thromboembolism complications after colorectal resection. ANZ J Surg 2020; 91:E32-E37. [PMID: 32356410 DOI: 10.1111/ans.15918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/30/2020] [Accepted: 04/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Earlier studies have shown that abnormal levels of haemoglobin and platelets may be associated with worse post-operative outcomes. We aim to compare the rates of venous thromboembolism (VTE), anastomotic leak and other complications in patients post-colorectal resection with normal and abnormal levels of haemoglobin and platelets. METHODS We performed a retrospective review of 1610 patients from July 2010 to June 2015 in a single colorectal unit. Our primary outcome was the rate of VTE and anastomotic leak in anaemic and thrombocytopenic patients. Secondary outcomes included length of stay, 30-day mortality, return to theatre, transfusion rates and Clavien-Dindo classification complications. RESULTS VTE complications were more common in anaemic patients, and this difference became more pronounced with the severity of anaemia. Other complications such as length of stay >2 weeks occurred more frequently in anaemic and thrombocytopenic patients. A trend towards higher rates of 30-day mortality and anastomotic leak was noted in patients with anaemia and thrombocytopenia. CONCLUSION Anaemia and thrombocytopenia are associated with worse outcomes including length of stay, anastomotic leak, VTE and 30-day mortality.
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Affiliation(s)
- Evie Yeap
- Colorectal Surgery Unit, Monash Health, Dandenong Hospital, Melbourne, Victoria, Australia
| | - William M K Teoh
- Colorectal Surgery Unit, Monash Health, Dandenong Hospital, Melbourne, Victoria, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Thang Chien Nguyen
- Colorectal Surgery Unit, Monash Health, Dandenong Hospital, Melbourne, Victoria, Australia
| | - Thomas Surya Suhardja
- Colorectal Surgery Unit, Monash Health, Dandenong Hospital, Melbourne, Victoria, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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27
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Elzefzafy WM, Abd Elrahman S, Mohmmed ZA, Atef N. Diagnostic utility of serum dipeptidyl peptidase (DPP- IV) /CD26 as a serum marker in Egyptian patients with colorectal cancer. J Immunoassay Immunochem 2020; 41:729-744. [PMID: 32223519 DOI: 10.1080/15321819.2020.1744642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is considered a major cause of morbidity and mortality in Egypt. Colonoscopy is the standard for detection of lesions. The combination of screening methods is effective. Decrease and loss of DPP-IV/CD26 expression and activity are found in microenvironments of specific tumors which are related to impaired immune functions. AIM OF THE WORK To study sCD26 as a noninvasive test in Egyptian patients with CRC as well as their correlation to CEA, CA 19-9 & other -biochemical parameters and determine the possibility to use it as a diagnostic tool for CRC. PATIENTS AND METHODS This study included 40 patients divided into two groups: group I: comprised 20 patients with CRC, group II: comprised 20 patients with other colorectal disease together with 20 healthy control. RESULTS There was highly significant decrease in sCD26 in group I in comparison to group II and III. CD26 at cutoff 4.69 mg/mL, its sensitivity was 85% and its specificity was 87.5%. CONCLUSION CD26 is involved in the pathogenesis of colorectal diseases; sCD26 is diminished in CRC patients suggesting the potential utility of a sCD26 for diagnosis.
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Affiliation(s)
- Wafaa M Elzefzafy
- Department of Hepatogastroentrology,infectious Disease, Faculty of Medicine (For Girls), Al-Azhar University , Cairo, Egypt
| | - Soheir Abd Elrahman
- Department of Clinicalpathology, Faculty of Medicine (For Girls), Al-Azhar University , Cairo, Egypt
| | - Zakia Abuzahab Mohmmed
- Department of Clinicalpathology, Faculty of Medicine (For Girls), Al-Azhar University , Cairo, Egypt
| | - Nesreen Atef
- Department of Clinicalpathology, Nasser Institute Hospital ,Cairo, Egypt
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28
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An Effective and Efficient Testing Protocol for Diagnosing Iron-deficiency Anemia Preoperatively. Anesthesiology 2020; 133:109-118. [PMID: 32205552 DOI: 10.1097/aln.0000000000003263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Iron-deficiency anemia is a common perioperative condition and increases perioperative morbidity and mortality. Timely diagnosis and treatment are important. This retrospective cohort study tested the hypothesis that a newly developed preprocedure evaluation protocol diagnoses more patients with iron-deficiency anemia than the traditional practice of obtaining a complete blood count followed by iron studies. METHODS The preprocedure anemia evaluation is an order for a complete blood count and reflex anemia testing, which can be completed with a single patient visit. A hemoglobin concentration of 12 g/dl or less with serum ferritin concentration less than 30 ng/ml or transferrin saturation less than 20% defined iron-deficiency anemia. Northwestern Medicine's database was queried for preoperative clinic patients, age 16 to 89 yr, before (2015 to 2016) and after (2017 to 2018) protocol implementation. The proportion of patients diagnosed with iron-deficiency anemia before and after the preprocedure anemia evaluation implementation was compared. RESULTS Before implementing the protocol, 8,816 patients were screened with a traditional complete blood count. Subsequent iron studies at the providers' discretion diagnosed 107 (1.2%) patients with iron-deficiency anemia. Some patients were still screened with a complete blood count after implementing the protocol; 154 of 4,629 (3.3%) patients screened with a complete blood count and 738 of 2,828 (26.1%) patients screened with the preprocedure anemia evaluation were diagnosed with iron-deficiency anemia. The preprocedure anemia evaluation identified a far larger proportion of patients with iron-deficiency anemia than did the traditional complete blood count when compared both before (relative risk [95% CI], 21.5 (17.6 to 26.2); P < 0.0001) and after (7.8 [6.6 to 9.3]; P < 0.0001) its implementation. CONCLUSIONS The preprocedure anemia evaluation improved identification of iron-deficiency anemia preoperatively. It is more effective and efficient, allowing anemia evaluation with a single patient visit.
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29
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Gómez-Ramirez S, Jericó C, Muñoz M. Perioperative anemia: Prevalence, consequences and pathophysiology. Transfus Apher Sci 2019; 58:369-374. [DOI: 10.1016/j.transci.2019.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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30
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The Association of Preoperative Anemia and the Postoperative Course and Oncological Outcome in Patients Undergoing Rectal Cancer Surgery: A Multicenter Snapshot Study. Dis Colon Rectum 2019; 62:823-831. [PMID: 31188183 DOI: 10.1097/dcr.0000000000001360] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is still controversy about the relationship between preoperative anemia and outcomes after rectal cancer surgery. OBJECTIVE The aim of this study was to analyze the association between preoperative anemia and postoperative complications and the survival of patients undergoing surgery for rectal cancer in the era of laparoscopic surgery and modern perioperative care. DESIGN This was a cohort study. SETTINGS Data were gathered from 71 hospitals in The Netherlands. PATIENTS Patients who underwent resection for rectal cancer in 2011, for whom preoperative hemoglobin level was registered, were included. INTERVENTIONS(S) There were no interventions. MAIN OUTCOME MEASURES Short-term outcome parameters were any postoperative complication or mortality within 30 days postoperatively, and pelvic infectious complications defined as anastomotic leakage and presacral abscess. Long-term outcomes were chronic sinus diagnosed at any time during 3-year follow-up, 3-year local and distant recurrence rates, and 3-year overall survival. RESULTS Of 2095 patients, 1857 had a registered preoperative hemoglobin level; 576 (31%) of these patients anemic and 1281 (69%) were nonanemic. Preoperative anemia was not independently associated with postoperative complications (HR, 1.1; 95% CI, 0.9-1.4; p = 0·24) or 30-day mortality (HR, 1.4, 95% CI, 0.7-2.8; p = 0·29). Preoperative anemia was associated with 3-year overall survival (HR, 2.1; 95% CI, 1.7-2.5; p < 0.0001), after multivariable analysis (HR, 1.4; 95% CI, 1.1-1.8; p = 0·008), and with local recurrence rate (HR, 1.6; 95% CI, 1.1-2.4; p = 0.026), but not with distant recurrence rate (HR, 1.2; 95% CI, 1.0-1.5; p = 0.054). LIMITATIONS Preoperative anemia appeared to have only limited association with postoperative and disease-specific outcome after rectal cancer surgery in contrast to published meta-analysis of small historical series. CONCLUSIONS Anemia is associated with overall survival. It might be considered as one of the warning signs in identifying high-risk patients. See Video Abstract at http://links.lww.com/DCR/A913.
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31
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Kwon HY, Kim BR, Kim YW. Association of preoperative anemia and perioperative allogenic red blood cell transfusion with oncologic outcomes in patients with nonmetastatic colorectal cancer. ACTA ACUST UNITED AC 2019; 26:e357-e366. [PMID: 31285680 DOI: 10.3747/co.26.4983] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background We investigated whether preoperative anemia and perioperative blood transfusion (pbt) are associated with overall survival and recurrence-free survival in patients with nonmetastatic colorectal cancer. Methods From 1 January 2009 to 31 December 2014, 1003 patients with primary colorectal cancer were enrolled in the study. Perioperative clinical and oncologic outcomes were analyzed based on the presence of preoperative anemia and pbt. Results Preoperative anemia was found in 468 patients (46.7%). In the anemia and no-anemia groups, pbt was performed in 44% and 15% of patients respectively. Independent predictors for pbt were preoperative anemia, higher American Society of Anesthesiologists score, laparotomy, lengthy operative time, advanced TNM stage, T4 stage, and 30-day morbidity. The use of pbt, but not preoperative anemia, was found to be an independent adverse prognostic factor for overall survival. In terms of recurrence-free survival, the presence of preoperative anemia was similarly not a significant prognostic factor, but the use of pbt was an independent factor for an unfavourable prognosis. Conclusions The use of pbt, but not preoperative anemia, was independently associated with worse overall and recurrence-free survival in nonmetastatic colorectal cancer. For better oncologic outcomes, our findings indicate a need to reduce the use of blood transfusion during the perioperative period.
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Affiliation(s)
- H Y Kwon
- Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, R.O.K
| | - B R Kim
- Health Promotion Center, Wonju Severance Christian Hospital, Wonju, R.O.K.,Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, R.O.K
| | - Y W Kim
- Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, R.O.K.,Big Data Research Group, Yonsei University Wonju College of Medicine, Wonju, R.O.K
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32
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Miles LF, Sandhu RNS, Grobler AC, Heritier S, Burgess A, Burbury KL, Story DA. Associations between non-anaemic iron deficiency and outcomes following surgery for colorectal cancer: An exploratory study of outcomes relevant to prospective observational studies. Anaesth Intensive Care 2019; 47:152-159. [DOI: 10.1177/0310057x19838899] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Iron deficiency is common in colorectal cancer. Despite perioperative guidelines advocating for the correction of non-anaemic iron deficiency prior to major surgery, the impact of this pathology on postoperative outcome is unclear. We conducted a single-centre, historical cohort study of 141 elective resections for colorectal cancer. We stratified non-anaemic patients into iron deficient and iron replete groups, and collected data on baseline characteristics, preoperative laboratory results, intraoperative events and postoperative outcomes. As this study was an exploratory work for future research, a P-value of 0.25 was considered relevant. Patients in the deficient group demonstrated lower baseline ferritin (median (interquartile range, IQR) 76 (41–141) µg/L versus 207 (140–334) µg/L, P < 0.001) and transferrin saturation (mean (standard deviation, SD) 18% (8%) versus 32% (12%), P < 0.001) than those in the replete group, and lower starting haemoglobin (mean (SD) 138 (10) g/L versus 144 (12) g/L, P = 0.01). The deficient group had increased re-admission (25% (24%) versus 4% (11%), P = 0.15) and all-cause infection (25% (24%) versus 5% (14%), P = 0.24). A decrease of two days in days alive and out of hospital at postoperative day 90 was seen in the deficient group on univariate analysis (median (IQR) 81 (75–84) versus 83 (78–84), P = 0.25). This reduced to 1.24 days in multivariate adjusted quantile regression analysis ( P = 0.22). Days alive and out of hospital at day 90, postoperative re-admission and postoperative infection may be meaningful outcome measures for future prospective observational work examining non-anaemic iron deficiency in patients undergoing major surgery for colorectal cancer.
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Affiliation(s)
- Lachlan F Miles
- Department of Anaesthesia, Austin Health, Melbourne, Australia
- Centre for Integrated Critical Care, Melbourne Medical School, University of Melbourne, Australia
| | | | | | - Stephane Heritier
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Adele Burgess
- Department of Colorectal Surgery, Austin Health, Melbourne, Australia
| | - Kate L Burbury
- Division of Haematology, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - David A Story
- Department of Anaesthesia, Austin Health, Melbourne, Australia
- Centre for Integrated Critical Care, Melbourne Medical School, University of Melbourne, Australia
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33
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Feng S, Greenberg J, Moloo H, Thavorn K, McIsaac DI. Hospital cost associated with anemia in elective colorectal surgery: a historical cohort study. Can J Anaesth 2019; 66:877-885. [PMID: 31044414 DOI: 10.1007/s12630-019-01379-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/28/2018] [Accepted: 01/20/2019] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Anemia is highly prevalent in the colorectal surgery population, affecting 30-70% of patients. Anemia is associated with significant morbidity and mortality; however, there is a lack of evidence on how much anemia impacts healthcare costs. This study aims to determine the hospital cost of index surgical admission, postoperative length of stay, and transfusion rate associated with preoperative anemia in elective major colorectal surgery. METHODS This historical cohort study included 851 adult inpatients having elective colorectal surgery at a tertiary care academic health sciences network between April 2010 and February 2016. Anemia was defined as hematocrit ≤ 39%. The primary outcome was total hospital costs standardized to 2016 CAD. Secondary outcomes were postoperative length of stay and transfusion. Multivariable regression analyses and propensity score methods were used to measure adjusted associations between anemia and outcomes. RESULTS Before surgery, 381/851 (45%) patients were anemic. The mean (standard deviation [SD]) cost of index admission for an elective colorectal surgery was 20,040 (23,219) CAD. Anemia was associated with an adjusted 14% relative increase in costs (95% confidence interval [CI], 6 to 23; P < 0.001). The total hospitalization cost attributable to anemia was 3,027 CAD (95% CI, 2,670 to 3,388). Hospital costs and length of stay were highly associated; anemia was associated with an 18% increase in length of stay (95% CI, 7 to 30; P < 0.001) and increased transfusion rates (risk ratio, 4.7; 95% CI, 2.71 to 8.33; P < 0.001). CONCLUSION Over 2,600 CAD per index surgical admission is attributable to preoperative anemia. Preoperative interventions with per patient cost of less than 2,600 CAD could be cost effective at the hospital level. TRIAL REGISTRATION www.clinicaltrials.gov (NCT03476707); registered 26 March, 2018.
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Affiliation(s)
- Simon Feng
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Joshua Greenberg
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Husein Moloo
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada. .,Ottawa Hospital Research Institute, Ottawa, ON, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. .,Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Civic Campus, Room B311, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
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34
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Gómez-Ramírez S, Bisbe E, Shander A, Spahn DR, Muñoz M. Management of Perioperative Iron Deficiency Anemia. Acta Haematol 2019; 142:21-29. [PMID: 30970362 DOI: 10.1159/000496965] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/16/2019] [Indexed: 01/28/2023]
Abstract
Preoperative anemia affects 30-40% of patients undergoing major surgery and is an independent risk factor for perioperative blood transfusion, morbidity, and mortality. Absolute or functional iron deficiency is its leading cause. Nonanemic hematinic deficiencies are also prevalent and may hamper preoperative hemoglobin optimization and/or recovery from postoperative anemia. As modifiable risk factors, anemia and hematinic deficiencies should be detected and corrected prior to major surgical procedures. Postoperative anemia is even more common (up to 80-90%) due to surgery-associated blood loss, inflammation-induced blunted erythropoiesis, and/or preexisting anemia. Preoperative oral iron may have a role in mild-to-moderate anemia, provided there is sufficient time (6-8 weeks) and adequate tolerance of oral preparations. Postoperative oral iron is of little value and rife with gastrointestinal adverse events. Intravenous iron should preferentially be used in cases of moderate-to-severe iron deficiency anemia, concomitant use of erythropoiesis-stimulating agents, short time to surgery or nonelective procedures, and for postoperative anemia management. Minor infusion reactions to intravenous iron are rare, the incidence of severe anaphylactic reactions is extremely low, and there is no increase in infections with intravenous iron. Currently available intravenous iron formulations allowing administration of large single doses are preferred.
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Affiliation(s)
- Susana Gómez-Ramírez
- Department of Internal Medicine, University Hospital Virgen de la Victoria, Málaga, Spain
| | - Elvira Bisbe
- Department of Anesthesiology, University Hospital Mar-Esperanza, Barcelona, Spain
| | - Aryeh Shander
- Departments of Anesthesiology, Critical Care, and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey, USA
- TeamHealth Research Institute, Englewood Health, Englewood, New Jersey, USA
| | - Donat R Spahn
- Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland
| | - Manuel Muñoz
- Department of Surgical Specialties, Biochemistry, and Immunology, School of Medicine, University of Málaga, Málaga, Spain,
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35
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Janssen TL, Mosk CA, van Hoof-de Lepper CCHA, Wielders D, Seerden TCJ, Steyerberg EW, van Gammeren AJ, de Lange DC, van Alphen R, van der Zee M, de Bruijn RM, de Vries J, Wijsman JH, Ho GH, Gobardhan PD, van der Laan L. A multicomponent prehabilitation pathway to reduce the incidence of delirium in elderly patients in need of major abdominal surgery: study protocol for a before-and-after study. BMC Geriatr 2019; 19:87. [PMID: 30894131 PMCID: PMC6427885 DOI: 10.1186/s12877-019-1101-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 03/06/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Due to the increase in elderly patients who undergo major abdominal surgery there is a subsequent increase in postoperative complications, prolonged hospital stays, health-care costs and mortality rates. Delirium is a frequent and severe complication in the 'frail' elderly patient. Different preoperative approaches have been suggested to decrease incidence of delirium by improving patients' baseline health. Studies implementing these approaches are often heterogeneous, have a small sample and do not provide high-quality or successful strategies. The aim of this study is to prevent postoperative delirium and other complications by implementing a unique multicomponent and multidisciplinary prehabilitation program. METHODS This is a single-center controlled before-and-after study. Patients aged ≥70 years in need of surgery for colorectal cancer or an abdominal aortic aneurysm are considered eligible. Baseline characteristics (such as factors of frailty, physical condition and nutritional state) are collected prospectively. During 5 weeks prior to surgery, patients will follow a prehabilitation program to optimize overall health, which includes home-based exercises, dietary advice and intravenous iron infusion in case of anaemia. In case of frailty, a geriatrician will perform a comprehensive geriatric assessment and provide additional preoperative interventions when deemed necessary. The primary outcome is incidence of delirium. Secondary outcomes are length of hospital stay, complication rate, institutionalization, 30-day, 6- and 12-month mortality, mental health and quality of life. Results will be compared to a retrospective control group, meeting the same inclusion and exclusion criteria, operated on between January 2013 and October 2015. Inclusion of the prehabilitation cohort started in November 2015; data collection is ongoing. DISCUSSION This is the first study to investigate the effect of prehabilitation on postoperative delirium. The aim is to provide evidence, based on a large sample size, for a standardized multicomponent strategy to improve patients' preoperative physical and nutritional status in order to prevent postoperative delirium and other complications. A multimodal intervention was implemented, combining physical, nutritional, mental and hematinic optimization. This research involves a large cohort, including patients most at risk for postoperative adverse outcomes. TRIAL REGISTRATION The protocol is retrospectively registered at the Netherlands National Trial Register (NTR) number: NTR5932 . Date of registration: 05-04-2016.
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Affiliation(s)
- Ties L Janssen
- Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands.
| | - Christina A Mosk
- Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands
| | | | - Daphne Wielders
- Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands
| | - Tom C J Seerden
- Department of Gastroenterology, Amphia Hospital, Breda, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC-University Medical center Rotterdam, Rotterdam, The Netherlands
| | - Adriaan J van Gammeren
- Department of Clinical Chemistry and Hematology, Amphia Hospital, Breda, The Netherlands
| | | | - René van Alphen
- Department of Physical Therapy, Amphia Hospital, Breda, The Netherlands
| | | | - René M de Bruijn
- Medical Manager Surgery, Amphia Hospital, Breda, The Netherlands
| | - Jolanda de Vries
- Department of Medical Psychology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Jan H Wijsman
- Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands
| | - Gwan H Ho
- Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands
| | - Paul D Gobardhan
- Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands
| | - Lijckle van der Laan
- Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands
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36
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Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, Hill AG, Soop M, de Boer HD, Urman RD, Chang GJ, Fichera A, Kessler H, Grass F, Whang EE, Fawcett WJ, Carli F, Lobo DN, Rollins KE, Balfour A, Baldini G, Riedel B, Ljungqvist O. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS ®) Society Recommendations: 2018. World J Surg 2019; 43:659-695. [PMID: 30426190 DOI: 10.1007/s00268-018-4844-y] [Citation(s) in RCA: 977] [Impact Index Per Article: 195.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This is the fourth updated Enhanced Recovery After Surgery (ERAS®) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS® protocol. METHODS A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS All recommendations on ERAS® protocol items are based on best available evidence; good-quality trials; meta-analyses of good-quality trials; or large cohort studies. The level of evidence for the use of each item is presented accordingly. CONCLUSIONS The evidence base and recommendation for items within the multimodal perioperative care pathway are presented by the ERAS® Society in this comprehensive consensus review.
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Affiliation(s)
- U O Gustafsson
- Department of Surgery, Danderyd Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - M J Scott
- Department of Anesthesia, Virginia Commonwealth University Hospital, Richmond, VA, USA
- Department of Anesthesiology, University of Pennsylvania, Philadelphia, USA
| | - M Hubner
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - J Nygren
- Department of Surgery, Ersta Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - N Demartines
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - N Francis
- Colorectal Unit, Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK
- University of Bath, Wessex House Bath, BA2 7JU, UK
| | - T A Rockall
- Department of Surgery, Royal Surrey County Hospital NHS Trust, and Minimal Access Therapy Training Unit (MATTU), Guildford, UK
| | - T M Young-Fadok
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - A G Hill
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland Middlemore Hospital, Auckland, New Zealand
| | - M Soop
- Irving National Intestinal Failure Unit, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - H D de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital, Groningen, The Netherlands
| | - R D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - G J Chang
- Department of Surgical Oncology and Department of Health Services Research, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - A Fichera
- Division of Gastrointestinal Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H Kessler
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, USA
| | - F Grass
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - E E Whang
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - W J Fawcett
- Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust and University of Surrey, Guildford, UK
| | - F Carli
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - D N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - K E Rollins
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - A Balfour
- Department of Colorectal Surgery, Surgical Services, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - G Baldini
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - B Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - O Ljungqvist
- Department of Surgery, Örebro University and University Hospital, Örebro & Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Laso-Morales MJ, Vives R, Vallejo-Tarrat A, Caló N, Valle-Beltran A, Pontes C. Single dose of intravenous ferric carboxymaltose infusion versus multiple fractionated doses of intravenous iron sucrose in the treatment of postoperative anaemia in colorectal cancer patients: study protocol for a randomised controlled trial. Trials 2019; 20:23. [PMID: 30616657 PMCID: PMC6323815 DOI: 10.1186/s13063-018-3125-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 12/11/2018] [Indexed: 11/23/2022] Open
Abstract
Background Patients with colorectal cancer (CRC) often present with associated anaemia which is usually present at the time of diagnosis and is aggravated during the postoperative period due to blood loss during the surgery process. Several guidelines advocate for the treatment of postoperative anaemia in these patients in order to prevent complications and allogeneic blood transfusions. However, there are no publications to shed light on the effectiveness of intravenous iron (IVI) administration after CRC surgery and the optimal dose and regimen. We have started a clinical trial with the objective of comparing the effectiveness of 1000 mg of ferric carboxymaltose with fractionated iron sucrose 200 g/48 h for the treatment of postoperative anaemia, by measuring the change of haemoglobin (Hb) levels from postoperative day (POD) 1 to POD 30. Methods We designed an open label randomised controlled trial to compare two postoperative IVI treatment regimens. Patients aged > 18 years undergoing CRC surgery, with Hb < 11 g/dL on POD 1 are randomly assigned to receive either 1000 mg of ferric carboxymaltose (single dose) or 200 g/48 h of iron sucrose. The main study endpoint will be the change from POD 1 to POD 30 in Hb levels and the key secondary endpoint the percentage of patients with Hb levels ≥ 13 g/dL at POD 30. Other secondary endpoints include: changes in iron metabolism parameters (Fe, ferritin, transferrin, % saturated trasferrin) at POD 30; total doses of iron received; number of postoperative transfusions; compliance with oral iron treatment; number of medical and surgical complications; adverse reactions reported by the patient; use of health resources after surgery; and changes in quality of life (QoL). It has been estimated that a sample of 48 patients per group will allow detecting a difference of 0.75 g/dL in Hb in the change in Hb levels from POD 1 to POD 30. Discussion The results of this study will confirm if the single dose of 1000 mg ferric carboxymaltose should be preferred in front of the fractionated doses and in which type of patients this regimen should be used preferably. Trial registration European Union Clinical Trials Register, EudraCT 2015-001005-13. Registered on 6 January 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-3125-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- María Jesús Laso-Morales
- Department of Anaesthesiology. Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Spain
| | - Roser Vives
- Clinical Pharmacology Unit, Department of Pharmacy. Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Spain. .,Departament de Farmacologia, de Terapèutica i de Toxicologia, Unitat Docent Parc Taulí, Universitat Autònoma de Barcelona, C/Parc Taulí, 1, 08208, Sabadell, Spain.
| | - Andrea Vallejo-Tarrat
- Department of Anaesthesiology. Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Spain
| | - Novella Caló
- Department of Anaesthesiology. Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Spain
| | - Anna Valle-Beltran
- Department of Anaesthesiology. Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Spain
| | - Caridad Pontes
- Clinical Pharmacology Unit, Department of Pharmacy. Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Spain.,Departament de Farmacologia, de Terapèutica i de Toxicologia, Unitat Docent Parc Taulí, Universitat Autònoma de Barcelona, C/Parc Taulí, 1, 08208, Sabadell, Spain
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A promising new approach to cancer therapy: Targeting iron metabolism in cancer stem cells. Semin Cancer Biol 2018; 53:125-138. [DOI: 10.1016/j.semcancer.2018.07.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 12/15/2022]
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Relationship of Red Blood Cell Distribution Width with Cancer Mortality in Hospital. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8914617. [PMID: 30539025 PMCID: PMC6261390 DOI: 10.1155/2018/8914617] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/23/2018] [Accepted: 10/21/2018] [Indexed: 12/19/2022]
Abstract
Background Red blood cell distribution width (RDW) is a clinical index used to make early diagnosis and to monitor treatment effects in iron deficiency anemia. Recently, several studies have suggested that RDW was associated with mortality from various cancers; however, there has been little evidence regarding RDW and cancer as a whole. Therefore, the purpose of our study was to investigate the relationship of RDW and overall cancer mortality in hospital. Methods We extracted patient data from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3 (MIMICIII.1.3). RDW was measured prior to hospital admission. Patients older than 18 who were diagnosed with malignant tumors were included. The primary outcome was cancer mortality in hospital. Logistic regression and multivariate analysis were used to assess the association between the RDW and hospital mortality. Result A total of 3384 eligible patients were enrolled. A positive correlation was observed between RDW and overall cancer mortality. Patients with higher RDW (14.4-16.3%, 16.4-30.5%) were at greater risk of death than the patients with RDW in the reference range (11.5-14.3%). On multivariate analysis, when adjusted for age and gender, the adjusted OR (95% CIs) in the mid-RDW group and high-RDW group were 1.61 (1.28, 2.03) and 2.52 (2.03, 3.13), respectively, with the low-RDW group set as the baseline. Similar trends were also observed in the model adjusted for other clinical characteristics. This suggested that elevated RDW was related to increased risk of cancer mortality, and RDW may play an important role in the prediction of short-term mortality after hospitalization in cancer patients. Conclusion Elevated RDW was associated with overall cancer mortality. To a certain extent, RDW may predict the risk of mortality in patients with cancers; it was an independent prognostic indicator of short-term mortality after hospitalization in cancer patients.
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Wilson MJ, Koopman-van Gemert AW, Harlaar JJ, Jeekel J, Zwaginga JJ, Schipperus M. Patient blood management in colorectal cancer patients: a survey among Dutch gastroenterologists, surgeons, and anesthesiologists. Transfusion 2018; 58:2345-2351. [DOI: 10.1111/trf.14807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Michael J. Wilson
- TRIP Hemovigilance and Biovigilance Office; Leiden The Netherlands
- Department of Surgery, Erasmus University Medical Center; Rotterdam The Netherlands
| | | | - Joris J. Harlaar
- Department of Surgery; VU Medical Center; Amsterdam The Netherlands
- Department of Surgery; Westfries Gasthuis; Hoorn The Netherlands
| | - Johannes Jeekel
- Department of Neuroscience; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research; Sanquin Research
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden The Netherlands
| | - Martin Schipperus
- TRIP Hemovigilance and Biovigilance Office; Leiden The Netherlands
- Department of Hematology; Haga Teaching Hospital; The Hague The Netherlands
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Shander A, Muñoz M, Spahn DR. Intravenous iron for severe iron deficiency anaemia. Br J Anaesth 2018; 121:342-344. [PMID: 30032871 DOI: 10.1016/j.bja.2018.05.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 05/22/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- A Shander
- Departments of Anaesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, and TeamHealth Research Institute, Englewood, NJ, USA.
| | - M Muñoz
- Department of Surgical Specialties, Biochemistry and Immunology, School of Medicine, Malaga, Spain
| | - D R Spahn
- Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland
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Current misconceptions in diagnosis and management of iron deficiency. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018; 15:422-437. [PMID: 28880842 DOI: 10.2450/2017.0113-17] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/30/2017] [Indexed: 12/15/2022]
Abstract
The prevention and treatment of iron deficiency is a major public health goal. Challenges in the treatment of iron deficiency include finding and addressing the underlying cause and the selection of an iron replacement product which meets the needs of the patient. However, there are a number of non-evidence-based misconceptions regarding the diagnosis and management of iron deficiency, with or without anaemia, as well as inconsistency of terminology and lack of clear guidance on clinical pathways. In particular, the pathogenesis of iron deficiency is still frequently not addressed and iron not replaced, with indiscriminate red cell transfusion used as a default therapy. In our experience, this imprudent practice continues to be endorsed by non-evidence-based misconceptions. The intent of the authors is to provide a consensus that effectively challenges these misconceptions, and to highlight evidence-based alternatives for appropriate management (referred to as key points). We believe that this approach to the management of iron deficiency may be beneficial for both patients and healthcare systems. We stress that this paper solely presents the Authors' independent opinions. No pharmaceutical company funded or influenced the conception, development or writing of the manuscript.
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Perelman I, Winter R, Sikora L, Martel G, Saidenberg E, Fergusson D. The Efficacy of Postoperative Iron Therapy in Improving Clinical and Patient-Centered Outcomes Following Surgery: A Systematic Review and Meta-Analysis. Transfus Med Rev 2018; 32:89-101. [DOI: 10.1016/j.tmrv.2017.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/19/2017] [Accepted: 10/16/2017] [Indexed: 02/07/2023]
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The post-operative management of anaemia: more efforts are needed. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018. [PMID: 29517972 DOI: 10.2450/2018.0036-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Intravenous iron administration for post-operative anaemia management after colorectal cancer surgery in clinical practice: a single-centre, retrospective study. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018. [PMID: 29517968 DOI: 10.2450/2018.0004-18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Evidence on the role of intravenous iron (IVI) supplementation after colorectal cancer (CRC) surgery is rather scant. This study was aimed at assessing the benefit of post-operative IVI administration after elective CRC surgery at our institution. MATERIALS AND METHODS This was a single-centre, retrospective observational study including all patients who underwent CRC surgery during 2014. Anaemia was defined as a haemoglobin (Hb) <13 g/dL, regardless of gender. Anaemic patients received 200 mg IVI up to three times a week to cover iron deficiency (IVI group). Those who did not receive IVI were placed on standard care (NIVI group). The primary outcome was the proportion of anaemic patients on post-operative day (POD)1 and POD30. Secondary outcomes included Hb changes from POD1 to POD30, transfusion requirements and complication rates. RESULTS Of the 159 patients studied, 139 (87%) presented with anaemia: 47 (34%) of these received post-operative IVI and 92 (66%) did not. Patients in the IVI group had lower POD1 Hb levels compared to those in the NIVI group (p=0.001). On POD30, only 103 had their Hb measured (34 IVI, 69 NIVI). Anaemia was more prevalent and more severe among the patients in the IVI group (p=0.027), despite their greater increment in Hb (2.0±1.5 g/dL vs 1.1±1.2 g/dL; p=0.001). Eleven patients needed post-operative transfusions (7 IVI, 4 NIVI; p=0.044). There were no differences in post-operative complication rates between the groups. No IVI-related adverse events were recorded DISCUSSION: Compared with standard care, post-operative IVI administration to anaemic patients improved the recovery of Hb levels at POD30, without increasing post-operative complications.
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Liu M, Zhou L, Zhang B, He M, Dong X, Lin X, Jia C, Bai X, Dai Y, Su Y, Zou Z, Zheng H. Elevation of n-3/n-6 PUFAs ratio suppresses mTORC1 and prevents colorectal carcinogenesis associated with APC mutation. Oncotarget 2018; 7:76944-76954. [PMID: 27769066 PMCID: PMC5363561 DOI: 10.18632/oncotarget.12759] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 10/10/2016] [Indexed: 11/25/2022] Open
Abstract
Although epidemiological and preclinical studies have shown the preventative effect of n-3 polyunsaturated fatty acids (PUFAs) on colorectal cancer (CRC), the underlying molecular mechanisms are not clear. In this study, we revealed that elevation of n-3/n-6 PUFAs ratio suppress the mechanistic target of rapamycin complex 1 (mTORC1) and prevent colorectal tumorigenesis. The transgenic expression of fat-1, a desaturase that catalyzes the conversion of n-6 to n-3 PUFAs and produces n-3 PUFAs endogenously, repressed colorectal tumor cell growth and remarkably reduced tumor burden, and alleviated anemia as well as hyperlipidemia in APCMin/+ (adenomatous polyposis coli) mice, a classic CRC model that best simulates most clinical cases. In contrast to arachidonic acid (AA, C20:4 n-6), either Docosahexaenoic acid (DHA, C22:6 n-3), eicosapentaenoic acid (EPA, C20:5 n-3), or a combination of DHA and AA, efficiently inhibited the proliferation of CRC cell lines and promoted apoptosis in these cells. The ectopic expression of fat-1 had similar effects in colon epithelial cells with APC depletion. Mechanistically, elevation of n-3/n-6 ratio suppressed mTORC1 activity in tumors of APCMin/+ mice, CRC cell lines with APC mutation, and in normal colon epithelial cells with APC depletion. In addition, elevation of n-3/n-6 ratio repressed mTORC1 activity and inhibited adipogenic differentiation in preadipocytes with APC knockdown, as well as alleviated hyperlipidemia in APCMin/+ mice. Taken together, our findings have provided novel insights into the potential mechanism by which increase in n-3/n-6 PUFAs ratio represses CRC development, and also a new rationale for utilizing n-3 PUFAs in CRC prevention and treatment.
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Affiliation(s)
- Miao Liu
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Ling Zhou
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Baiyu Zhang
- Department of Rheumatology, The Sixth Affiliated Hospital of Sun Yat-Sen University, 510655, China
| | - Minhong He
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Xiaoying Dong
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Xiaojun Lin
- Department of Cell Biology, School of Basic Medical Science, Southern Medical University, Guangzhou 510515, China
| | - Chunhong Jia
- Department of Cell Biology, School of Basic Medical Science, Southern Medical University, Guangzhou 510515, China
| | - Xiaochun Bai
- Department of Cell Biology, School of Basic Medical Science, Southern Medical University, Guangzhou 510515, China
| | - Yifan Dai
- State Key Laboratory of Reproductive Medicine and Jiangsu Key Laboratory of Xenotransplantation, Nanjing Medical University, Nanjing 201129, China
| | - Yongchun Su
- Department of Bioinformatics, School of Basic Medical Science, Southern Medical University, Guangzhou 510515, China
| | - Zhipeng Zou
- Department of Cell Biology, School of Basic Medical Science, Southern Medical University, Guangzhou 510515, China
| | - Hang Zheng
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Brynjarsdottir ED, Sigurdsson MI, Sigmundsdottir E, Möller PH, Sigurdsson GH. Prospective study on long-term outcome after abdominal surgery. Acta Anaesthesiol Scand 2018; 62:147-158. [PMID: 29094339 DOI: 10.1111/aas.13025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/04/2017] [Accepted: 10/11/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Complications following major abdominal surgery are common and an important cause of morbidity and mortality. The aim of this study was to describe 1-year mortality and identify factors that influence adverse outcomes after abdominal surgery. METHODS This prospective observational cohort study was performed in Landspitali University Hospital and included all adult patients undergoing abdominal surgery requiring > 24-h hospital admission over 13 months. The follow-up period was 60 days for complications and 24 months for mortality. RESULTS Data were available for 1113 (99.5%) of the 1119 patients who fulfilled inclusion criteria. A total of 23% of patients had at least one underlying co-morbidity. Non-elective surgeries were 48% and 13% of the patients were admitted to ICU post-operatively. A total of 20% of patients developed complications. Mortality at 30 days, 1 and 2 years was 1.8%, 5.6%, and 8.3% respectively. One-year mortality for those admitted to ICU was 18%. The long-term survival of the individuals surviving 30 days was significantly worse than for an age- and gender-matched population control group. Independent predictors for 1-year mortality were age, pre-operative acute kidney injury and intermediate- or major surgery. CONCLUSION Post-operative complication rates and mortality following abdominal surgery in Iceland were comparable or in the lower range of previously published outcomes, validating the utility of offering a full host of abdominal surgical services in geographically isolated region with a relatively small referral base.
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Affiliation(s)
- E. D. Brynjarsdottir
- Department of Internal Medicine; Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
- Faculty of Medicine; University of Iceland; Reykjavik Iceland
| | - M. I. Sigurdsson
- Department of Anesthesiology; Duke University School of Medicine; Durham NC USA
| | - E. Sigmundsdottir
- Department of Anaesthesia and Intensive Care Medicine; Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
| | - P. H. Möller
- Faculty of Medicine; University of Iceland; Reykjavik Iceland
- Department of Surgery; Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
| | - G. H. Sigurdsson
- Faculty of Medicine; University of Iceland; Reykjavik Iceland
- Department of Anaesthesia and Intensive Care Medicine; Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
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Multimodal Prehabilitation Programs as a Bundle of Care in Gastrointestinal Cancer Surgery: A Systematic Review. Dis Colon Rectum 2018; 61:124-138. [PMID: 29219922 DOI: 10.1097/dcr.0000000000000987] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prehabilitation reflects a proactive process of preoperative optimization undertaken between cancer diagnosis and definitive surgical treatment, with the intent of improving physiological capacity to withstand the major insult of surgery. Prehabilitation before GI cancer surgery is currently not widely adopted, and most research has focused on unimodal interventions such as exercise therapy, nutritional supplementation, and hematinic optimization. A review of the existing literature was undertaken to investigate the impact of multimodal prehabilitation programs as a "bundle of care." DATA SOURCE A systematic literature search was performed utilizing Medline, PubMed, Embase, Cinahl, Cochrane, and Google Scholar databases. STUDY SELECTION The quality of studies was assessed by using the Cochrane tool for assessing risk of bias (randomized trials) and the Newcastle-Ottawa Quality Assessment scale (cohort studies). INTERVENTION Studies were chosen that involved pre-operative optimization of patients before GI cancer surgery. MAIN OUTCOMES The primary outcome measured was the impact of prehabilitation programs on preoperative fitness and postoperative outcomes. RESULTS Of the 544 studies identified, 20 were included in the qualitative analysis. Two trials investigated the impact of multimodal prehabilitation (exercise, nutritional supplementation, anxiety management). Trials exploring prehabilitation with unimodal interventions included impact of exercise therapy (7 trials), impact of preoperative iron replacement (5 trials), nutritional optimization (5 trials), and impact of preoperative smoking cessation (2 trials). Compliance within the identified studies was variable (range: 16%-100%). LIMITATIONS There is a lack of adequately powered trials that utilize objective risk stratification and uniform end points. As such, a meta-analysis was not performed because of the heterogeneity in study design. CONCLUSION Although small studies are supportive of multimodal interventions, there are insufficient data to make a conclusion about the integration of prehabilitation in GI cancer surgery as a bundle of care. Larger, prospective trials, utilizing uniform objective risk stratification and structured interventions, with predefined clinical and health economic end points, are required before definitive value can be assigned to prehabilitation programs.
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