Joint effect of pre-operative anemia and perioperative blood transfusion on outcomes of colon-cancer patients undergoing colectomy

Abstract Background Both pre-operative anemia and perioperative (intra- and/or post-operative) blood transfusion have been reported to increase post-operative complications in patients with colon cancer undergoing colectomy. However, their joint effect has not been investigated. The purpose of this study was to evaluate the joint effect of pre-operative anemia and perioperative blood transfusion on the post-operative outcome of colon-cancer patients after colectomy. Methods We identified patients from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database 2006–2016 who underwent colectomy for colon cancer. Multivariate logistic regression analysis was employed to assess the independent and joint effects of anemia and blood transfusion on patient outcomes. Results A total of 35,863 patients—18,936 (52.8%) with left-side colon cancer (LCC) and 16,927 (47.2%) with right-side colon cancer (RCC)—were identified. RCC patients were more likely to have mild anemia (62.7%) and severe anemia (2.9%) than LCC patients (40.2% mild anemia and 1.4% severe anemia). A total of 2,661 (7.4%) of all patients (1,079 [5.7%] with LCC and 1,582 [9.3%] with RCC) received a perioperative blood transfusion. Overall, the occurrence rates of complications were comparable between LCC and RCC patients (odds ratio [OR] = 1.01; 95% confidence interval [CI] = 0.95–1.07; P = 0.750). There were significant joint effects of anemia and transfusion on complications and the 30-day death rate (P for interaction: 0.010). Patients without anemia who received a transfusion had a higher risk of any complications (LCC, OR = 3.51; 95% CI = 2.55–4.85; P < 0.001; RCC, OR = 3.74; 95% CI = 2.50–5.59; P < 0.001), minor complications (LCC, OR = 2.54; 95% CI = 1.63–3.97; P < 0.001; RCC, OR = 2.27; 95% CI = 1.24–4.15; P = 0.008), and major complications (LCC, OR = 5.31; 95% CI = 3.68–7.64; P < 0.001; RCC, OR = 5.64; 95% CI = 3.61–8.79; P < 0.001), and had an increased 30-day death rate (LCC, OR = 6.97; 95% CI = 3.07–15.80; P < 0.001; RCC, OR = 4.91; 95% CI = 1.88–12.85; P = 0.001) than patients without anemia who did not receive a transfusion. Conclusions Pre-operative anemia and perioperative transfusion are associated with an increased risk of post-operative complications and increased death rate in colon-cancer patients undergoing colectomy.

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Cancer Related Anemia in the Era of Erythropoietin Stimulating Agents (ESA)Uncertainty: A Single Cancer Institution Experience.

Blood ◽

10.1182/blood.v114.22.5085.5085 ◽

2009 ◽

Vol 114 (22) ◽

pp. 5085-5085

Author(s):

Hikmat Abdel-Razeq ◽

Shadi B Hijjawi ◽

Hazem Abdulelah ◽

Yousef Ismael ◽

Rula Amarin ◽

...

Keyword(s):

Blood Transfusion ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Combined Treatment ◽

Disease Stage ◽

Severe Anemia ◽

Primary Cancer ◽

Mild Anemia ◽

Erythropoietin Stimulating Agents ◽

Prevalence Of Anemia

Abstract Abstract 5085 Anemia is the most common hematological abnormality in cancer patients. Unfortunately, it is often under-recognized and under-treated. The pathogenesis of cancer anemia is complex and most of the time multifactorial; involving factors related to the tumor itself or its therapy. Recombinant human erythropoietin stimulating agents (ESA) was widely used to prevent and treat cancer and chemotherapy-related anemia. However, many recent studies involving patients with different kind of cancers at different stages of their disease suggested a negative impact on disease progression and survival when such ESA were used to keep Hemoglobin (Hb) at a higher level. The US Food and Drug Administration (FDA) announced revisions and warning to restrict ESA indications. This report describes the prevalence of anemia in cancer patients and its management given the recent confusion and uncertainties. Methods We retrospectively reviewed all consecutive adult cancer patients admitted to regular medical units between Jan and Dec, 2008. Patients admitted to Leukemia, Bone Marrow Transplantation and Intensive Care Units were excluded. Demographic features, reasons for admission, primary cancer diagnosis and disease stage were determined. All patients with Hb value < 12 g/dL at any time during admission were considered anemic. Treatment offered for anemia was also reviewed. Subsequent admissions for the same patients during the study period were also followed up. Results 959 patients (51% males, median age 55 years, range 18- 91) admitted 1862 times were included. Reasons for admission at time of enrollment included chemotherapy (23%), infections including neutropenic fever (20%), palliative and supportive care (15%). Other reasons included pulmonary, neurological, renal and electrolyte imbalances. Primary cancer diagnosis included: Gastrointestinal (21%), Breast (16%), Lymphoma and Multiple Myeloma (16%), and Lung (11%). At time of enrollment, 55% of patients had advanced stage disease. Anemia at any time during admission was detected in 755 (78.7%) patients. Mean Hb value for anemic patients was 9.51 g/dL (range 3.5-11.9, median 9.6). Severe anemia (Hb < 8) was documented in 16.7%, moderate anemia (Hb 8-10) in 41.9% and mild anemia (Hb > 10) in 41.5% of the patients. Majority (69%) of the patients were not offered any treatment for their anemia. Among the total group, blood transfusion was offered for 25%, supplements (including iron, folate and or vitamin B12) for 3.3%. ESA were offered for only 1.1%. Few patients (2.1%) had combined treatment. Mean Hb value at which treatment was started was 8 g/dL, while mean Hb for the patients who were not treated was 10.2 g/dL. Most of the patients (94%) with severe anemia, 32% with the moderate, and 5% of the patients with mild anemia were treated as shown in the table. Conclusions Anemia among adult cancer patients admitted to regular medical units is quiet common. Given the recent FDA warning and the many confusing studies, the prevalence of anemia in cancer patients was found to be high; many of such patients were not offered any treatment. The threshold to start treatment was highly dependent on its severity. Blood transfusion was the most common treatment method. Quality improvement projects should be implemented to better recognize and treat anemia in cancer patients. Disclosures No relevant conflicts of interest to declare.

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Perioperative blood transfusion in cancer patients undergoing laparoscopic colorectal resection: risk factors and impact on survival

Techniques in Coloproctology ◽

10.1007/s10151-013-1014-y ◽

2013 ◽

Vol 17 (5) ◽

pp. 549-554 ◽

Cited By ~ 16

Author(s):

R. Ghinea ◽

R. Greenberg ◽

I. White ◽

E. Sacham-Shmueli ◽

H. Mahagna ◽

...

Keyword(s):

Risk Factors ◽

Blood Transfusion ◽

Cancer Patients ◽

Colorectal Resection ◽

Laparoscopic Colorectal Resection ◽

Impact On Survival ◽

Perioperative Blood Transfusion

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Standard and multivisceral colectomy in locally advanced colon cancer

Radiology and Oncology ◽

10.2478/raon-2020-0032 ◽

2020 ◽

Vol 54 (3) ◽

pp. 341-346

Author(s):

Artur M. Sahakyan ◽

Andranik Aleksanyan ◽

Hovhannes Batikyan ◽

Hmayak Petrosyan ◽

Mushegh А. Sahakyan

Keyword(s):

Colon Cancer ◽

Blood Transfusion ◽

Locally Advanced ◽

Multivisceral Resection ◽

Tumor Location ◽

Safe Procedure ◽

Advanced Colon Cancer ◽

Visceral Peritoneum ◽

T4 Colon Cancer ◽

Perioperative Blood Transfusion

AbstractBackgroundManagement of locally advanced colon cancer (LACC) is challenging. Surgery is the mainstay of the treatment, yet its outcomes remain unclear, especially in the setting of multivisceral resections. The aim of the study was to examine the outcomes of standard and multivisceral colectomy in patients with LACC.Patients and methodsPatients demographics, clinical and perioperative data of patients operated within study period 2004–2018 were collected. LACC was defined as stage T4 colon cancer including tumor invasion either through the visceral peritoneum or to the adjacent organs/structures. Accordingly, either standard or multivisceral colectomy (SC and MVC) was performed.ResultsTwo hundred and three patients underwent colectomy for LACC. Of those, 112 had SC (55.2%) and 91 (44.8%) had MVC. Severe morbidity and mortality rates were 5.9% and 2.5%, respectively. MVC was associated with an increased blood loss (200 ml vs. 100 ml, p = 0.01), blood transfusion (22% vs. 8.9%, p = 0.01), longer operative time (180 minutes vs. 140 minutes, p < 0.01) and postoperative hospital stay (11 days vs. 10 days, p < 0.01) compared with SC. The complication-associated parameters were similar. Male gender, presence of ≥ 3 comorbidities, tumor location in the left colon and perioperative blood transfusion were associated with complications in the univariable analysis. In the multivariable model, the presence of ≥ 3 comorbidities was the only independent predictor of complications.ConclusionsColectomy with or without multivisceral resection is a safe procedure in LACC. In experienced hands, the postoperative outcomes are similar for SC and MVC. Given the complexity of the latter, these procedures should be reserved to qualified expert centers.

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Anemia and perioperative mortality in Non-cardiac Surgery patients: a secondary analysis based on a single-center retrospective study

10.21203/rs.2.22901/v3 ◽

2020 ◽

Author(s):

Xueying Luo ◽

Feng Li ◽

Haofei Hu ◽

Baoer Liu ◽

Sujing Zheng ◽

...

Keyword(s):

Cardiac Surgery ◽

Blood Transfusion ◽

Severe Anemia ◽

Perioperative Mortality ◽

Icu Admission ◽

Mild Anemia ◽

Postoperative Blood Transfusion ◽

Doubly Robust Estimation ◽

Anemia Group ◽

Doubly Robust

Abstract Background : Evidence regarding the relationship between anemia and perioperative prognosis is controversial. The study was conducted to highlight the specific relationship between anemia and perioperative mortality in non-cardiac surgery patients over 18 years of age. Methods: This study was a retrospective analysis of the electronic medical records of 90,784 patients at the Singapore General Hospital from January 1, 2012 to October 31, 2016. Multivariate regression, propensity score analysis, doubly robust estimation, and an inverse probability-weighting model was used to ensure the robustness of our findings. Results : We identified 85,989 patients, of whom75, 163 had none or mild anemia(Hemoglobin>90g/L) and 10,826 had moderate or severe anemia(Hemoglobin≤90g/L). 8,857 patients in each study exposure group had similar propensity scores and were included in the analyses. In the doubly robust model, postoperative 30-day mortality rate was increased by 0.51% (n = 219) in moderate or severe anemia group (Odds Ratio, 1.510; 95% Confidence Interval(CI), 1.049 to 2.174) compared with none or mild anemia group (2.47% vs. 1.22%, P<0.001). Moderate or severe anemia was also associated with increased postoperative blood transfusion rates (OR, 5.608; 95% CI, 4.026 to 7.811, P < 0.001).There was no statistical difference in Intensive Care Unit(ICU) admission rate among different anemia groups within 30 days after surgery (P=0.104). Discussion: In patients undergoing non-cardiac surgery over 18 years old, moderate or severe preoperative anemia would increase the occurrence of postoperative blood transfusion and the risk of death, rather than ICU admission within 30 days after surgery.

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