Preop Iron Therapy Helps Long-Term Outcomes After Colorectal Cancer Surgery

Male Surgeon and Surgical Assistant in operating room of hospital performing Endoscopy procedure on patient, colonoscopy, crc, polyp
This study analyzed the long-term outcomes of patients undergoing colorectal cancer surgery who received either oral or intravenous iron replacement therapy.

Researchers determined preoperative anemia correction with iron may lead to better survival 5 years after elective colorectal cancer (CRC) surgery and observed no significant differences between oral iron (OI) and intravenous iron (IVI), according to study results in Colorectal Disease.

In the Intravenous Iron in Colorectal Cancer Associated Anemia (IVICA) trial, investigators randomly assigned 116 patients with anemic CRC to receive either OI (control) or IVI (treatment) before their elective operations. They conducted a follow-up analysis of all patients who underwent surgical resection with curative intent, as well as a pooled group multivariable analysis comparing patients who achieved resolution of anemia preoperatively with patients who did not.

A total of 110 patients were eligible for the analysis: 56 patients received OI, and 54 received IVI. Among patients who received OI, the mean age was 75.2 (±11.1) years, and 61% were male. Among patients who received IVI, the mean age was 74.1 (±8.8) years and 65% were male. The median overall follow-up duration was 61 (interquartile range, 38-68) years.

The researchers found no significant difference in the 5-year overall survival (hazard ratio [HR] 1.22; 95% CI, 0.65-2.28; P =.522) or disease-free survival (HR 1.08; 95% CI, 0.61-1.92; P =.79) between the OI and IVI groups. On multivariable analysis, overall survival was higher among treatment responders (HR 3.38; 95% CI, 1.07-11.56; P =.044) compared with nonresponders; however, the differences in improved disease-free survival and cancer-specific survival were not significant between these subgroups.

“Perhaps surprisingly there was a high degree of concordance between treatment groups for [CRC] specific survival,” noted the researchers. “Intravenous iron is now being favored in many centers as the treatment of choice in the perioperative setting, particularly for rapid preoperative correction of anemia. These findings therefore support this shift in practice, particularly with regards to oncological safety… Our observation that [IVI] provided a more sustained hemoglobin response postoperatively when compared to [OI] should further support its use.”

The study authors noted that the original trial was not powered to undertake this subgroup analysis, and because of the relatively small number of patients, a type 2 error could have occurred, resulting in an inaccurate estimation of any treatment effect when comparing groups.

“These findings, when interpreted in combination with previous data demonstrating superior efficacy of IVI compared to standard care or [OI], support the continued use of [IVI] treatment to correct preoperative anemia,” the investigators commented.

Disclosures: Some of the authors reported affiliations with the pharmaceutical industry. Please see the original reference for a full list of the authors’ disclosures.

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Dickson EA, Keeler BD, Ng O, Kumar A, Brookes MJ, Acheson AG; IVICA trial group. Preoperative intravenous iron therapy and survival after colorectal cancer surgery: long-term results from the IVICA randomised controlled trial. Published online September 1, 2020. Colorectal Dis. doi: 10.1111/codi.15342