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Impacts of anemia and transfusion on oncologic outcomes in patients undergoing surgery for colorectal cancer

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Abstract

Purpose

This study aimed to evaluate the prevalence of preoperative anemia and impacts of anemia and transfusion on survival in patients undergoing surgery for colorectal cancer.

Methods

This study included patients who underwent surgery for primary colorectal cancer between 2011 and 2012. The influence of preoperative anemia and postoperative transfusion on recurrence-free survival and overall survival were retrospectively investigated. Anemia was defined as hemoglobin level < 13 g/dL in males and < 12 g/dL in females. The primary outcome was the prevalence of preoperative anemia in patients with colorectal cancer. Secondary outcomes included preoperative anemia management, postoperative 30-day mortality and morbidity, tumor recurrence, and overall survival.

Results

Among a total of 1899 patients, 823 patients (43.3%) were anemic preoperatively, and 264 patients (13.9%) received postoperative transfusions. Postoperative transfusion was associated with 30-day postoperative complications (OR = 1.514, 95% CI = 1.020 ~ 2.247) but not preoperative anemia (OR = 1.143, 95% CI, 0.811 ~ 1.611). Preoperative anemia (HR = 1.459, 95% CI = 1.104 ~ 1.929) and postoperative transfusion (HR = 1.566, 95% CI = 1.089 ~ 2.252) were significantly associated with worse recurrence-free survival in multivariable analysis. Preoperative anemia (HR = 1.572, 95% CI = 1.274 ~ 1.940) and postoperative transfusion (HR = 1.381, 95% CI = 1.076 ~ 1.773) were significant independent risk factors for worse overall survival.

Conclusions

Preoperative anemia and postoperative transfusion were associated with worse survival in patients undergoing surgery for colorectal cancer. An alternative therapy to treat anemia and reduce transfusions should be introduced to improve oncologic outcomes.

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Acknowledgments

The abstract from the poster presentation at the meeting of The European Society of Coloproctology was published in the 2018 September issue of Colorectal Disease (https://doi.org/10.1111/codi.14328). English language editing and review services were supplied by the American Journal Experts.

Funding

This study was funded by JW Pharmaceutical, Seoul, Republic of Korea.

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Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Yoon-Hye Kwon, Han-Ki Lim, Min Jung Kim, Ji Won Park, Seung-Bum Ryoo, Seung-Yong Jeong & Kyu Joo Park

Authors
  1. Yoon-Hye Kwon
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  2. Han-Ki Lim
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  3. Min Jung Kim
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  4. Ji Won Park
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  7. Kyu Joo Park
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Contributions

Kyu Joo Park, Seung-Yong Jeong, and Ji Won Park designed the study; Yoon-Hye Kwon, Min Jung Kim, and Seung-Bum Ryoo analyzed the data; and Yoon-Hye Kwon and Han-Ki Lim wrote the manuscript.

Corresponding author

Correspondence to Kyu Joo Park.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics approval

This study was approved by the Institutional Review Board of Seoul National University Hospital (IRB number H-1704-052-844).

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Informed consent was waived by the board.

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Not applicable.

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Kwon, YH., Lim, HK., Kim, M.J. et al. Impacts of anemia and transfusion on oncologic outcomes in patients undergoing surgery for colorectal cancer. Int J Colorectal Dis 35, 1311–1320 (2020). https://doi.org/10.1007/s00384-020-03601-2

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