Laso-Morales MaríaJesús, Jericó Carlos, Gómez-Ramírez Susana, Castellví Jordi, Viso Lorenzo, Roig-Martínez Inmaculada, Pontes Caridad, Muñoz Manuel
Department of Anesthesiology, Corporació Sanitarìa Parc Taulí, Sabadell, Spain.
Department of Internal Medicine, Hospital Sant Joan Despí Moisés Broggi-Consorci Sanitari Integral, Barcelona, Spain.
Transfusion. 2017 Dec;57(12):3040-3048. doi: 10.1111/trf.14278. Epub 2017 Aug 21.
Preoperative anemia prevalence among colorectal cancer (CRC) patients is high and may adversely influence postoperative outcome. This study assesses the efficacy of a preoperative anemia managing protocol in CRC.
This was a retrospective analysis of consecutive CRC resections at two Spanish centers (January 2012 to December 2013). Preoperative anemia was defined as a hemoglobin (Hb) level of less than 13 g/dL and treated with intravenous iron (IVI) or standard care (oral iron or no iron). Red blood cell transfusion (RBCT) requirements was the primary outcome variable. Postoperative infection rate and length of hospital stay (LOS) were secondary outcome variables. Patients were managed with a restrictive transfusion trigger (Hb < 8 g/dL). Infection was diagnosed clinically and confirmed by laboratory, microbiologic, and/or radiologic evidence.
Overall, 322 of 571 patients (56%) presented with anemia: 232 received IVI and 90 standard care. There were differences in RBCT rate between no anemia and anemia (2% vs. 16%; p < 0.01), but not in postoperative infections (19% vs. 22%; p = NS) or LOS. Compared to those on standard care, anemic patients on IVI presented with lower Hb (10.8 g/dL vs. 12.0 g/dL; p < 0.001) at baseline, but similar Hb on day of surgery and Postoperative Day 30. There were no between-group differences in RBCT rates (16% vs. 17%; p = NS), but infection rates were lower among IVI-treated patients (18% vs. 29%; p < 0.05). No relevant IVI-related side effects were recorded.
Compared to standard care, IVI was more effective in treating preoperative anemia in CRC patients and appeared to reduce infection rate, although it did not reduce postoperative RBCT.
结直肠癌（CRC）患者术前贫血患病率较高，可能对术后结果产生不利影响。本研究评估了一种术前贫血管理方案在结直肠癌中的疗效。
这是一项对西班牙两个中心（2012年1月至2013年12月）连续进行的结直肠癌切除术的回顾性分析。术前贫血定义为血红蛋白（Hb）水平低于13 g/dL，并采用静脉铁剂（IVI）或标准治疗（口服铁剂或不使用铁剂）进行治疗。红细胞输注（RBCT）需求是主要结局变量。术后感染率和住院时间（LOS）是次要结局变量。患者采用限制性输血触发阈值（Hb < 8 g/dL）进行管理。感染通过临床诊断，并经实验室、微生物学和/或放射学证据证实。
总体而言，571例患者中有322例（56%）出现贫血：232例接受IVI治疗，90例接受标准治疗。无贫血和贫血患者的RBCT率存在差异（2%对16%；p < 0.01），但术后感染（19%对22%；p = 无显著性差异）或LOS无差异。与接受标准治疗的患者相比，接受IVI治疗的贫血患者基线时Hb较低（10.8 g/dL对12.0 g/dL；p < 0.001），但手术当天和术后第30天的Hb相似。两组之间的RBCT率无差异（16%对17%；p = 无显著性差异），但IVI治疗患者的感染率较低（18%对29%；p < 0.05）。未记录到与IVI相关的相关副作用。
与标准治疗相比，IVI在治疗结直肠癌患者术前贫血方面更有效，并且似乎降低了感染率，尽管它并未降低术后RBCT。
