@article{0a69dce84c6140ef85a3c42b59e476c7,
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. Conclusion: 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.",
author = "{the IVICA Trial Group} and Keeler, {B. D.} and Simpson, {J. A.} and O. Ng and H. Padmanabhan and Brookes, {M. J.} and Acheson, {A. G.} and A. Banerjea and C. Walter and C. Maxwell-Armstrong and J. Williams and J. Scholefield and J. Abercrombie and M. Robinson and P. Vitish-Sharma and N. Bhandal and C. Gornall and A. Petsas and K. Ward and S. Pyke and P. Johnson and H. Cripps and G. Williams and Green, {M. E.} and J. Rankin and T. Pinkney and T. Iqbal and D. Ward and C. Tselepis and M. Narewal and K. Futaba and M. Ghods-Ghorbani and J. Lund and E. Theophilidou and O. Peacock and R. Longman and N. Francis and K. Spurdle and D. Miskovic and C. Moriarty",
note = "Funding Information: M.J.B. and A.G.A. are joint senior authors of this article. The Ferinject? used in the trial was donated to all study centres, except Nottingham University Hospitals NHS Trust, by Vifor Pharma (Glattbrugg, Switzerland). The study represents independent research funded by the National Institute for Health Research (NIHR), UK (grant number PB-PG-0110-21041). The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health. Disclosure: The research department of M.J.B. has received grant support from Syner-Med (UK) and Vifor Pharma (Switzerland). M.J.B. has received honoraria and travel support for consulting or lecturing from Vifor Pharma and Merck Sharp and Dohme Limited (UK). The research department of A.G.A. has received grant support from Syner-Med (UK), Vifor Pharma (Switzerland) and Pharmacosmos (Denmark). A.G.A. has received honoraria and travel support for consulting or lecturing from Ethicon Endosurgery (UK), Johnson & Johnson (UK), Olympus (UK) and Vifor Pharma (Switzerland). O.N. has received honoraria and travel support for consulting from Pharmacosmos, Denmark. Publisher Copyright: {\textcopyright} 2017 BJS Society Ltd Published by John Wiley & Sons Ltd",
year = "2017",
month = feb,
day = "1",
doi = "10.1002/bjs.10328",
language = "English (US)",
volume = "104",
pages = "214--221",
journal = "British Journal of Surgery",
issn = "0007-1323",
publisher = "John Wiley and Sons Ltd",
number = "3",
}