MANAGING PREOPERATIVE ANAEMIA IN COLORECTAL CANCER: COMPARATIVE EFFECTIVENESS OF IV AND ORAL IRON

Introduction: Colorectal cancer (CRC) is among the most commonly reported malignancies globally, taking the third place in incidence among males as well as second among females, with over 1.9 million new cases and 935,000 deaths estimated worldwide only in 2020. One of the most common and clinically significant comorbidities in patients undergoing CRC surgery is preoperative anemia, with reported prevalence ranging from 23% to over 60% depending on the population and diagnostic criteria used.

Purpose: The objective of the current study is to systematically evaluate the current body of evidence on preoperative anemia management in adults undergoing surgery for non-metastatic CRC and assess the clinical impact of different iron supplementation strategies in intravenous (IV) versus oral (PerOs) iron for pre-operative hematologic optimization, transfusion requirements, postoperative complications, and recovery outcomes.

Methodology: The current systematic review was conducted based on the PRISMA for Systematic Reviews and Meta-analysis checklist. The study has been registered to PROPSERO on with ID CRD420251113455.

Results: Across the 4 randomized control trials included, IV iron consistently improved hemoglobin, ferritin, and transferrin saturation more effectively than PerOs iron, when administered ≥14 days preoperatively. Epoetin alfa diminished transfusion requirements and improved hematocrit levels without elevating thromboembolic risk. Surgical interventions comprised right or left hemicolectomy, anterior resection, and low anterior or abdominoperineal resection, with laparoscopic techniques employed in 40–60% of instances. Hemoglobin normalization was attained in 40–70% of patients, contingent upon the timing and strength of the intervention.

Conclusion: It is observed that, IV iron therapy offers a more effective strategy than PerOs supplementation for correcting preoperative anemia in non-metastatic colorectal cancer patients. Its hematologic benefits enhance surgical readiness and reduce postoperative intervention needs, supporting the integration of IV iron into preoperative optimization protocols.