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Preoperative Epoetin Alfa in Colorectal Surgery: A Randomized, Controlled Study

Department of Surgical Oncology, University Hospital, Medical School University of Crete, PO Box 1352, 71110, Herakleion, Greece

Correspondence: Address correspondence and reprint requests to: Dimitris D. Tsiftsis, MD, PhD, FACS, for the Hellenic Surgical Oncology Perioperative EPO Study Group; E-mail: tsiftsis{at}med.uoc.gr.

Background: Colorectal cancer patients are often anemic before surgery, and this leads to an increased requirement for allogeneic blood transfusion. This may result in transfusion-induced immunosuppression, which in turn leads to increased morbidity and possibly an increased rate of tumor relapse. We investigated the possible benefits of perioperative epoetin alfa administration in anemic patients to correct hemoglobin levels and reduce transfusion needs.

Methods: A total of 223 colorectal cancer patients with anemia scheduled for surgery were randomized to a group that received epoetin alfa 150 or 300 IU/kg/day subcutaneously for 12 days (day –10 to +1) or to a control group. All received iron (200 mg/day by mouth) for 10 days before surgery. Hemoglobin levels, hematocrit, and the number of blood units transfused were recorded.

Results: A total of 204 patients were eligible for analysis. Mean hemoglobin levels and hematocrit were significantly higher in the 300 IU/kg group than in the control group, both 1 day before surgery (hemoglobin, P = .008; hematocrit, P = .0005) and 1 day after surgery (hemoglobin, P = .011; hematocrit, P = .0008). Blood loss during and after surgery was similar in all groups. Patients who received epoetin alfa 300 IU/kg required significantly fewer perioperative transfusion units than control patients (.81 vs. 1.32; P = .016) and significantly fewer postoperative units (.87 vs. 1.33; P = .023). There were no significant differences in the number of units in the 150 IU/kg group.

Conclusions: Preoperative epoetin alfa (300 IU/day) increases hemoglobin levels and hematocrit in colorectal surgery patients. These effects are associated with a reduced need for perioperative and postoperative transfusions.

Key Words: Colorectal cancer • Epoetin alfa • Recombinant human erythropoietin • Hematocrit • Hemoglobin • Transfusion

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