Efficacy of Different Interventions to Reduce Pre- or Perioperative Blood Transfusion Rate in Patients with Colorectal Cancer: A Network Meta-Analysis of Randomized Controlled Trials

Division of General Surgery, Department of Surgery, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan. School of Medicine, College of Medicine, I-Shou University, Kaohsiung 84001, Taiwan. Department of Otorhinolaryngology, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan. Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung 811, Taiwan. Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan. Department of Psychology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan. Gender Equality Education and Research Center, Asia University, Taichung 413, Taiwan. Department of Medical Research, Asia University Hospital, Asia University, Taichung 413, Taiwan. Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 406040, Taiwan. Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan. Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan.

Current oncology (Toronto, Ont.). 2021;28(4):3214-3226
Abstract
BACKGROUND The high proportion of blood transfusions before and during surgery carries unnecessary risk and results in poor prognosis in colorectal cancer patients. Different pharmacological interventions (i.e., iron supplement or recombinant erythropoietin) to reduce blood transfusion rates have shown inconclusive results. METHODS This network meta-analysis (NMA) consisted of randomized controlled trials (RCTs) comparing the efficacy of different pharmacologic interventions (i.e., iron supplementation or recombinant erythropoietin) to reduce the blood transfusion rate. NMA statistics were conducted using the frequentist model. Results: Seven RCTs (688 participants) were included in this study. The NMA demonstrated that the combination of high-dose recombinant human erythropoietin and oral iron supplements was associated with the least probability of receiving a blood transfusion [odds ratio = 0.24, 95% confidence intervals (95% CIs): 0.08 to 0.73] and best reduced the amount of blood transfused if blood transfusion was necessary (mean difference = -2.62 U, 95% CI: -3.55 to -1.70 U) when compared to the placebo/control group. None of the investigated interventions were associated with any significantly different dropout rate compared to the placebo/control group. CONCLUSIONS The combination of high-dose recombinant human erythropoietin and oral iron supplements might be considered as a choice for reducing the rate of blood transfusion in patients with colorectal cancer. However, future large-scale RCT with long-term follow-up should be warranted to approve the long-term safety.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine