Integrated approach for the preoperative correction of anemia for liver resection in patients with colorectal liver metastases

Aim. To study the features of the pathogenesis of anemia in patients with colorectal cancer and metastatic liver damage, as well as to evaluate the effectiveness of etiological correction of anemia in the preoperative period.

Methods. 90 patients with colorectal liver metastases and anemia (hemoglobin content 75–95 g/L), who were observed at the City Clinical Oncological Center of St. Petersburg between 2014 and 2020, were included. The patients were divided into two groups. The first group consisted of prospectively assessed patients with the preoperative correction of anemia by iron supplements (intravenously 7 mg/kg once a week) and recombinant erythropoietin (subcutaneously 150 IU/kg 3 times a week). The second group included retrospectively assessed patients with the correction of anemia only by red blood cell (RBC) transfusion (1–3 doses). The groups were comparable for gender [sex ratio (male/female) was 17:31 and 16:26 for the first and the second groups, respectively; p >0.5], age (63.3±1.4 and 60.2±1.2 years, respectively; p >0.1) and hemoglobin content (87.4±1.0 and 86.7±0.9 g/l, respectively; p >0.2).

Results. In studying the causes of anemia, a decrease in the mean serum endogenous erythropoietin level was revealed in most patients (36.7±1.9 mIU/ml with the required 70 mIU/ml). A decrease in the concentration of serum iron (6.6±0.3 versus 15.1±0.8 μmol/l) and ferritin (15.5±1.9 versus 102.4±8.4 μg/ml) levels were revealed. At the same time, there was no difference in the concentration of pro-inflammatory cytokines in patients with anemia and healthy controls (tumor necrosis factor α, interleukin-1β, interleukin-6; p >0.2), which indicates a low activity of the immune system in response to a tumor, due to conducted chemotherapy. In the preoperative correction of anemia, a positive effect was achieved with both iron supplementation with erythropoietin preparation (the hemoglobin level increased from 87.6±1.0 to 108.1±0.9 g/l; p <0.01) and RBC transfusion (from 86.7±0.9 to 114.6±0.6 g/l; p <0.01).

Conclusion. In patients with colorectal liver metastases, the most common causes of anemia were low levels of erythropoietin and iron deficiency; also for this group of patients, the prescription of erythropoietin and intravenous iron preparations are effective for the preoperative correction of anemia.