Preoperative blood management in colorectal cancer surgery: the controversial role of iron

Wilson, M.J. (2018)

Doctoral Thesis

The general aim of this thesis was to evaluate the role of iron in anemic patients with solid cancer, with special attention to the long-term oncological effects of iron therapy in the preoperative setting. In this thesis, this role of iron is specifically studied in the context of colorectal cancer.
In chapter 2 the results of a systematic review and meta-analysis demonstrate that preoperative anemia was significantly associated with decreased overall survival and disease-free survival. In the third chapter, results showed that 50 percent of all colorectal cancer patients, and 80 percent of all anemic colorectal cancer patients were iron deficient. In chapter 4 it was shown that a distinct variability was present in preoperative blood management practices not only between, but also within Dutch hospitals. Regarding the efficacy of preoperative intravenous iron therapy, in chapter 5 it was demonstrated that iron therapy is most effective in patients presenting with more severe anemia, and with higher transferrin and lower ferritin levels. In chapter 7, our study failed to demonstrate that preoperative intravenous iron therapy has a profound effect on long-term overall and disease-free survival in anemic colorectal cancer patients.

• Blood transusion
• Blood management
• Iron therapy
• Colorectal cancer
• Prehabilitation

• All authors: Wilson, M.J.
• Supervisor: Zwaginga, J.J.
• Co-supervisor: Jeekel, J.; Schipperus, M.
• Committee: Brand, A.; Verhoef, C.; Dekker, J.W.T.; Bonsing, B.A.
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2018-01-18