Anemia as a predictor of poor outcomes in colorectal cancer surgery: A literature review

Cover Page

Cite item

Full Text

Abstract

Background. Iron deficiency anemia is a frequent consequence of colorectal cancer (CRC) which might lead to poor treatment outcomes.

Aim. To conduct a review analyzing the correlation between preoperative anemia and treatment outcomes (mortality, morbidity, survival) in CRC patients.

Materials and methods. The literature search was conducted in PubMed (NCBI) and Cochrane databases. Key query terms: colorectal cancer, anemia, mortality and survival rates, blood loss, hemotransfusion. The review included articles discussing the prevalence of anemia in CRC and its association with mortality, morbidity, survival.

Results. Anemia was found in 32–52% of CRC patients before surgery. It correlated well with higher incidence of postoperative morbidity and mortality as well as lower overall survival. The same findings were true regarding intraoperative blood loss and perioperative blood transfusion.

Conclusions. Preoperative anemia is a major modifiable prognostic factor in CRC patients along with intraoperative blood loss and perioperative transfusion. Thus, strong efforts should be invested in the development of patient blood management protocols. The most effective method of solving this complex problem is the introduction into clinical practice of the patient blood management concept, which includes the use of intravenous iron preparations at the preoperative stage, correction of coagulopathy, a comprehensive approach to intraoperative blood conservation, an extremely strict approach in determining the indications for hemotransfusion.

About the authors

Dmitrii O. Kornev

Yudin Moscow City Hospital; Novokuznetsk State Institute for Further Training of Physicians – Branch Campus of the Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: korn3v.dmit@yandex.ru

oncologist

Russian Federation, Moscow; Novokuznetsk

Vladimir K. Lyadov

Yudin Moscow City Hospital; Novokuznetsk State Institute for Further Training of Physicians – Branch Campus of the Russian Medical Academy of Continuous Professional Education; Russian Medical Academy of Continuous Professional Education

Email: vlyadov@gmail.com
ORCID iD: 0000-0002-7281-3591
SPIN-code: 5385-7889

D. Sci. (Med.)

Russian Federation, Moscow; Novokuznetsk; Moscow

References

  1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-63. doi: 10.3322/caac.21834
  2. Злокачественные новообразования в России в 2022 году (заболеваемость и смертность). Под ред. А.Д. Каприна, В.В. Старинского, А.О. Шахзадовой, И.В. Лисичниковой. М.: МНИОИ им. П.А. Герцена − филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2023 [Zlokachestvennye novoobrazovaniia v Rossii v 2022 godu (zabolevaemost' i smertnost'). Pod red. A.D. Kaprina, V.V. Starinskogo, A.O. Shakhzadovoi, I.V. Lisichnikovoi. Moscow: MNIOI im. P.A. Gertsena − filial FGBU «NMITs radiologii» Minzdrava Rossii, 2023 (in Russian)].
  3. Miller KD, Nogueira L, Devasia T, et al. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin. 2022;72(5):409-36. doi: 10.3322/caac.21731
  4. Ludwig H, Van Belle S, Barrett-Lee P, et al. The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer. 2004;40(15):2293-306. doi: 10.1016/j.ejca.2004.06.019
  5. Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011;378(9800):1396-407. doi: 10.1016/S0140-6736(11)61381-0
  6. Amato A, Pescatori M. Perioperative blood transfusions and recurrence of colorectal cancer. Cochrane Database Syst Rev. 2006;2006(1):CD005033. doi: 10.1002/14651858.CD005033.pub2
  7. Leichtle SW, Mouawad NJ, Lampman R, et al. Does preoperative anemia adversely affect colon and rectal surgery outcomes? J Am Coll Surg. 2011;212(2):187-94. doi: 10.1016/j.jamcollsurg.2010.09.013
  8. Simoes CM, Carmona MJC, Hajjar LA, et al. Predictors of major complications after elective abdominal surgery in cancer patients. BMC Anesthesiol. 2018;18(1):49. doi: 10.1186/s12871-018-0516-6
  9. Mörner ME, Edgren G, Martling A, et al. Preoperative anaemia and perioperative red blood cell transfusion as prognostic factors for recurrence and mortality in colorectal cancer-a Swedish cohort study. Int J Colorectal Dis. 2017;32(2):223-32. doi: 10.1007/s00384-016-2678-3
  10. Egenvall M, Morner M, Martling A, Gunnarson U. Prediction of Outcome after Curative Surgery for Colorectal Cancer: Preoperative Haemoglobin, CRP and Albumin. Colorectal Dis. 2018;20(1):26-34. doi: 10.1111/codi.13807
  11. 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. Curr Oncol. 2019;26(3):e357-66. doi: 10.3747/co.26.4983
  12. Wilson MJ, Dekker JWT, Harlaar JJ, et al. The role of preoperative iron deficiency in colorectal cancer patients: prevalence and treatment. Int J Colorectal Dis. 2017;32(11):1617-24. doi: 10.1007/s00384-017-2898-1
  13. Tokunaga R, Nakagawa S, Miyamoto Y, et al. The impact of preoperative anaemia and anaemic subtype on patient outcome in colorectal cancer. Colorectal Dis. 2019;21(1):100-9. doi: 10.1111/codi.14425
  14. Simillis C, Charalambides M, Mavrou A, et al. Operative blood loss adversely affects short and long-term outcomes after colorectal cancer surgery: results of a systematic review and meta-analysis. Tech Coloproctol. 2023;27(3):189-208. doi: 10.1007/s10151-022-02701-1
  15. Charalambides M, Mavrou A, Jennings T, et al. A systematic review of the literature assessing operative blood loss and postoperative outcomes after colorectal surgery. Int J Colorectal Dis. 2022;37(1):47-69. doi: 10.1007/s00384-021-04015-4
  16. Moncur A, Chowdhary M, Chu Y, Francis NK. Impact and outcomes of postoperative anaemia in colorectal cancer patients: a systematic review. Colorectal Dis. 2021;23(4):776-86. doi: 10.1111/codi.15461
  17. Pang QY, An R, Liu HL. Perioperative transfusion and the prognosis of colorectal cancer surgery: a systematic review and meta-analysis. World J Surg Oncol. 2019;17(1):7. doi: 10.1186/s12957-018-1551-y

Copyright (c) 2024 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies