Skip to main content
SpringerLink
Log in

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

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Foster RS, Costanza MC, Foster JC, et al. Adverse relationship between blood transfusions and survival after colectomy for colon cancer Cancer 1985;55:1195–201

    PubMed  Google Scholar 

  2. Parrott NR, Lennard TWJ, Taylor RMR, et al. Effect of perioperative blood transfusion on recurrence of colorectal cancer Br J Surg 1986;73:970–3

    PubMed  Google Scholar 

  3. Vamvakas EC, Blajchman MA. Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction? Blood 2001;97:1180–95

    Article  PubMed  Google Scholar 

  4. Blumberg N, Heal JM. Effects of transfusion on immune function: cancer recurrence and infection Arch Pathol Lab Med 1994;118:371–9

    PubMed  Google Scholar 

  5. Busch OR, Hop WC, Marquet RL, et al. Blood transfusions and local tumor recurrence in colorectal cancer: evidence of a noncausal relationship Ann Surg 1994;220:791–7

    PubMed  Google Scholar 

  6. Chung M, Steinmetz OK, Gordon PH. Perioperative blood transfusion and outcome after resection for colorectal carcinoma Br J Surg 1993;80:427–32

    PubMed  Google Scholar 

  7. Heiss MM, Mempel W, Jauch KW, et al. Beneficial effect of autologous blood transfusion on infectious complications after colorectal cancer surgery Lancet 1993;342:1328–33

    Article  PubMed  Google Scholar 

  8. Heiss MM, Mempel W, Delanoff C, et al. Blood transfusion-modulated tumor recurrence: first results of a randomized study of autologous versus allogeneic blood transfusion in colorectal cancer surgery J Clin Oncol 1994;12:1859–67

    PubMed  Google Scholar 

  9. Kressner U, Graf W, Mahteme H, et al. Septic complications and prognosis after surgery for rectal cancer Dis Colon Rectum 2002;45:316–21

    Article  PubMed  Google Scholar 

  10. Motoyama S, Saito R, Kamata S, et al. Survival advantage of using autologous blood transfusion during surgery for esophageal cancer Surg Today 2002;32:951–8

    Article  PubMed  Google Scholar 

  11. Tartter PI. The association of perioperative blood transfusion with colorectal cancer recurrence Ann Surg 1992;216:633–8

    PubMed  Google Scholar 

  12. Van de Watering LM, Brand A, Houbiers JG, et al. Perioperative blood transfusions, with or without allogeneic leucocytes, relate to survival, not to cancer recurrence Br J Surg 2001;88:267–72

    Article  PubMed  Google Scholar 

  13. Hoynck van Papendtecht MAW, Hop W, Langenhorst BLAM, et al. Feasibility of a predeposit autologous blood donation program in colorectal cancer patients: results from a randomized clinical study Vox Sang 1992;62:102–7

    PubMed  Google Scholar 

  14. Hansen E, Wolff N, Knuechel R, et al. Tumor cells in blood shed from the surgical field Arch Surg 1995;130:387–93

    PubMed  Google Scholar 

  15. Yaw PB, Sentany M, Link WJ, et al. Tumor cells carried through autotransfusion Contraindication to intraoperative blood recovery? JAMA 1975;231:490–1

    Article  PubMed  Google Scholar 

  16. Goodnough LT, Skikne B, Brugnara C. Erythropoietin, iron, and erythropoiesis Blood 2000;96:823–33

    PubMed  Google Scholar 

  17. Braga M, Gianotti L, Vignali A, et al. Evaluation of recombinant human erythropoietin to facilitate autologous blood donation before surgery in anaemic patients with cancer of the gastrointestinal tract Br J Surg 1995;82:1637–40

    PubMed  Google Scholar 

  18. Canadian Orthopedic Perioperative Erythropoietin Study Group. Effectiveness of perioperative recombinant human erythropoietin in elective hip replacement Lancet 1993;341:1227–32

    Google Scholar 

  19. Goodnough LT, Rudnick S, Price TH, et al. Increased preoperative collection of autologous blood with recombinant human erythropoietin therapy N Engl J Med 1989;321:1163–8

    PubMed  Google Scholar 

  20. Mercuriali F, Zanella A, Barosi G, et al. Use of erythropoietin to increase the volume of autologous blood donated by orthopedic patients Transfusion 1993;33:55–60

    Article  PubMed  Google Scholar 

  21. Sowade O, Warnke H, Scigalla P, et al. Avoidance of allogeneic blood transfusions by treatment with epoetin beta (recombinant human erythropoietin) in patients undergoing open-heart surgery Blood 1997;89:411–8

    PubMed  Google Scholar 

  22. Qvist N, Boesby S, Wolff B, et al. Recombinant human erythropoietin and hemoglobin concentration at operation and during the postoperative period: reduced need for blood transfusions in patients undergoing colorectal surgery—prospective double-blind placebo-controlled study World J Surg 1999;23:30–5

    Article  PubMed  Google Scholar 

  23. Kickler TS, Spivak JL. Effect of whole blood donations on serum immunoreactive erythropoietin levels in autologous donors JAMA 1988;260:65–7

    Article  PubMed  Google Scholar 

  24. Miller CB, Jones RJ, Piantadosi S, et al. Decreased erythropoietin response in patients with the anemia of cancer N Engl J Med 1990;322:1689–92

    PubMed  Google Scholar 

  25. Heiss MM, Tarabichi A, Delanoff C, et al. Perisurgical erythropoietin application in anemic patients with colorectal cancer: a double-blind randomized study Surgery 1996;119:523–7

    PubMed  Google Scholar 

  26. Kettelhack C, Hones C, Messinger D, et al. Randomized multicentre trial of the influence of recombinant human erythropoietin on intraoperative and postoperative transfusion need in anaemic patients undergoing right hemicolectomy for carcinoma Br J Surg 1998;85:63–7

    Article  PubMed  Google Scholar 

  27. Falkson CI, Keren-Rosenberg S, Uys A, et al. Recombinant human erythropoietin in the treatment of cancer-related anaemia Oncology 1994;51:497–501

    PubMed  Google Scholar 

  28. Adamson JW, Spivak JL. Physiologic basis for the pharmacologic use of recombinant human erythropoietin in surgery and cancer treatment Surgery 1994;115:7–15

    PubMed  Google Scholar 

  29. Tsuji Υ, Kambayashi J, Shiba E, Sakon M, Kawasaki T, Mori T. Effect of recombinant human erythropoietin on anaemia after gastrectomy: a pilot study Eur J Surg 1995;161:29–33

    PubMed  Google Scholar 

  30. Sowade B, Sowade O, Mocks J, et al. The safety of treatment with recombinant human erythropoietin in clinical use: a review of controlled studies Int J Mol Med 1998;1:303–14

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, University Hospital, Medical School University of Crete, 1352, , 71110, Herakleion, Greece

    Manoussos Christodoulakis MD & Dimitris D. Tsiftsis MD, PhD, FACS

Authors
  1. Manoussos Christodoulakis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dimitris D. Tsiftsis MD, PhD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dimitris D. Tsiftsis MD, PhD, FACS.

Additional information

See Appendix 1 for a list of investigators in the Hellenic Surgical Oncology Perioperative EPO Study Group.

Appendix 1: Investigators For The Hellenic Surgical OncologyPerioperative Epo Study Group

Appendix 1: Investigators For The Hellenic Surgical OncologyPerioperative Epo Study Group

E. Tsimogianis, Ioannina Hospital; E. Sanidas and P. Taflampas, Herakleion University Hospital; T. Chrisidis and K. Saliagas, Edessa Hospital; A. Tentes, Didimotiho Hospital; N. Chatzigeorgiou, G. Chrisafis, and S. Oikonomou, Theagenio Hospital; P. Vrachnos, KAT Hospital; C. Christakis, B’IKA Hospital; C. Farfarelos and V. Zompolas, Metaxa Hospital; J. Bramis, Laiko University Hospital; J. Androulakis and M. Stavropoulos, Patra University Hospital; D. Tsantilas, Hippokratio Thes. University Hospital; S. Skaltsas and S. Triantafilidis, Patision Hospital; E. Molis, Drama Hospital; K. Karamosxos, Papageorgiou Hospital; K. Chatzitheofilou and M. Spyridakis, Larisa University Hospital; P. Vasilopoulos and G. Platoniotis, Agios Savas Hospital; and A. Kapas and M. Fatouros, Ioannina University Hospital.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Christodoulakis, M., Tsiftsis, D.D. Preoperative Epoetin Alfa in Colorectal Surgery: A Randomized, Controlled Study. Ann Surg Oncol 12, 718–725 (2005). https://doi.org/10.1245/ASO.2005.06.031

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/ASO.2005.06.031

Keywords

Search

Navigation