Blood management of patients with stage II–III colorectal cancer: Results of a comparative study

Background. Anemia is a common complication in patients with colorectal cancer (CRC), affecting 30–67% of patients, depending on the stage and location of the tumor. Anemia, blood loss as well as allogenic hemotransfusion all worsen immediate and long-term outcomes for the patients. Aim. To analyze the effectiveness of patient blood management (PBM) in patients with II–III stage CRC undergoing elective surgery. Materials and methods. We analyzed in a prospective way the results of surgical treatment in 100 stage II–III CRC patients with iron-deficient anemia who underwent surgical treatment in Moscow State Budgetary Healthcare Institution “Oncological Center No. 1 of Moscow City Hospital named after S.S. Yudin, Moscow Healthcare Department” in 2022–2023. PBM included out-patient anemia correction with ferric carboxymaltosate, intraoperative blood loss minimization as well as smaller volume of postoperative blood control and more definitive indications for blood transfusion. Control group was retrospective and included 100 patients with anemia and stage II–III CRC who underwent surgery in 2019–2021 without anemia correction and other PBM interventions. Results. The groups were comparable according to patient sex, body mass index, tumor location, the extent of surgery. However, patients in the control group were younger and less morbid. There were no adverse reactions after ferric carboxymaltosate infusion. Mean hemoglobin before correction was 91.2±10.1 g/l and 121±17 g/l before surgery (р0.001). The use of PBM significantly reduced the intraoperative blood loss volume (66 vs 112 ml, р0.0001) as well as the incidence of severe postoperative complications (OR 0.36, 95% CI 0.19–0.68; p0.001). In particular, patients in the study group had a lower incidence of anastomotic leakage (0 vs 8; p0.001) and wounds infections/eventrations (3 vs 10; p0.001). Conclusion. The use of PBM in patients with CRC and anemia has a potential to reduce the number of postoperative