title: Randomized clinical trial of preoperative oral versus intravenous iron in anaemic patients with colorectal cancer.
abstract: BACKGROUND
  Treatment of preoperative anaemia is recommended as part of patient blood management, aiming to minimize perioperative allogeneic red blood cell transfusion. No clear evidence exists outlining which treatment modality should be used in patients with colorectal cancer. The study aimed to compare the efficacy of preoperative intravenous and oral iron in reducing blood transfusion use in anaemic patients undergoing elective colorectal cancer surgery.
  
  
  METHODS
  Anaemic patients with non-metastatic colorectal adenocarcinoma were recruited at least 2 weeks before surgery and randomized to receive oral (ferrous sulphate) or intravenous (ferric carboxymaltose) iron. Perioperative changes in haemoglobin, ferritin, transferrin saturation and blood transfusion use were recorded until postoperative outpatient review.
  
  
  RESULTS
  Some 116 patients were included in the study. There was no difference in blood transfusion use from recruitment to trial completion in terms of either volume of blood administered (P = 0·841) or number of patients transfused (P = 0·470). Despite this, increases in haemoglobin after treatment were higher with intravenous iron (median 1·55 (i.q.r. 0·93-2·58) versus 0·50 (-0·13 to 1·33) g/dl; P < 0·001), which was associated with fewer anaemic patients at the time of surgery (75 versus 90 per cent; P = 0·048). Haemoglobin levels were thus higher at surgery after treatment with intravenous than with oral iron (mean 11·9 (95 per cent c.i. 11·5 to 12·3) versus 11·0 (10·6 to 11·4) g/dl respectively; P = 0·002), as were ferritin (P < 0·001) and transferrin saturation (P < 0·001) levels.
  
  
  CONCLUSIONS
  Intravenous iron did not reduce the blood transfusion requirement but was more effective than oral iron at treating preoperative anaemia and iron deficiency in patients undergoing colorectal cancer surgery.
authors.affiliation: National Institute for Health Research Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK.|Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: B D
authors.initials: BD
authors.lastname: Keeler
authors.affiliation: National Institute for Health Research Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK.|Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Simpson
authors.affiliation: National Institute for Health Research Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK.|Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: O
authors.initials: O
authors.lastname: Ng
authors.affiliation: School of Cancer Sciences, University of Birmingham, Birmingham, UK.|Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK.
authors.forename: H
authors.initials: H
authors.lastname: Padmanabhan
authors.affiliation: School of Cancer Sciences, University of Birmingham, Birmingham, UK.|Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Brookes
authors.affiliation: National Institute for Health Research Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK.|Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: A G
authors.initials: AG
authors.lastname: Acheson
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D015179:Colorectal Neoplasms / Q000150:complications / Q000601:surgery*; D017558:Elective Surgical Procedures; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage* / Q000627:therapeutic use; D005296:Ferrous Compounds / Q000008:administration & dosage* / Q000627:therapeutic use; D005500:Follow-Up Studies; D006397:Hematinics / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008320:Maltose / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D005290:Ferric Compounds; D005296:Ferrous Compounds; D006397:Hematinics; C020748:ferrous sulfate; C522335:ferric carboxymaltose; D008320:Maltose