Nicola Raftery, Niamh Ni Leathlobhair, Conor Murphy, Michelle Fanning, David Koshy, Narayanasamy Ravi, John Vincent Reynolds
Background: Iron-deficiency anaemia is common amongst cancer patients undergoing major surgery and may be an important determinant perioperative morbidity, postoperative recovery, and long-term outcomes. We sought to establish the rates of iron deficiency and iron-deficiency anaemia in patients before and after oesophagectomy, and to explore the relationship with red cell transfusion requirements, inpatient length of stay (LOS), and medication use.
Methods: A retrospective analysis of prospectively recorded data from consecutive patients undergoing oesophagectomy with curative intent since incorporation of a quality-of-life focused survivorship clinic in October 2017 at St. James’s Hospital, Dublin, was performed. Preoperatively, and 8–10 weeks postoperatively, clinical and biochemical measures were collected. Iron deficiency was defined using a serum ferritin <30 ug/L with normal inflammatory markers, or <100 ug/L or transferrin saturation <20%, if c-reactive protein was elevated >5 mg/L. Sex-specific haemoglobin thresholds were used to diagnose anaemia (females: <12 g/dL, males: <13 g/dL).
Results: Forty patients [85% male, mean ± standard deviation (SD) aged 61.9±11.4 years] underwent oesophagectomy [transhiatal, 13 (32.5%), Ivor-Lewis 22 (55%), McKeown 5 (12.5%)], with 62.5% receiving neoadjuvant therapy. Median (range) postoperative LOS was 13.2 (7.1–79.1) days. Preoperative, and follow up [55.8 (24.3-106.5) days], prevalence of iron deficiency was 50.0% vs. 65.7% (P=0.23), and iron-deficiency anaemia, 34.2% vs. 45.7% (P=0.39), respectively. 10 (25%) patients required ≥1 in-hospital transfusion (one preoperative, two intraoperative, eight postoperative). Preoperative iron status was not associated with postoperative LOS (P=0.33) or with transfusion (P=0.69). There was no significant relationship between medications and iron deficiency.
Conclusions: Iron deficiency and iron-deficiency anaemia are prevalent in patients undergoing oesophagectomy at a high-volume centre, and rates increase postoperatively, although clinical significance is unclear, requiring further exploration of functional and long-term outcomes.
