Bd Keeler

The feasibility and clinical efficacy of intravenous iron administration for preoperative anaemia in patients with colorectal cancer

The study aimed to analyse the feasibility and efficacy of administration of a single intravenous iron infusion (IVI) in the preoperative optimization of colorectal cancer patients with anaemia.

The influence of laparoscopy on incisional hernia rates: a retrospective analysis of 1057 colorectal cancer resections

The aim of this study was to evaluate the incidence of incisional hernia formation after laparoscopic and open surgery for colorectal cancer.

Iron chelation: a potential therapeutic strategy in oesophageal cancer

Raised intracellular iron has been identified as a potential aetiological factor in the development of several epithelial malignancies, including those of the gastrointestinal tract. The mechanism behind this increase is thought to include disorders of iron uptake and storage. Several iron chelators have been identified as potential anti‐tumour agents, with much work undertaken to ascertain the exact mode of action. Despite this, there is little known about the role that these drugs play in the cellular iron metabolism of oesophageal cancer. Consequently, the present study looks to review the relationship of two clinically important iron‐chelating agents, deferoxamine and deferasirox, on cellular iron uptake and storage in oesophageal squamous and adenocarcinoma. This provides important evidence for the debate about the role these agents have in the clinical management of such tumours.

A cohort investigation of anaemia, treatment and the use of allogeneic blood transfusion in colorectal cancer surgery

Introduction Preoperative identification and treatment of anaemia is advocated as part of Patient Blood Management due to the association of adverse outcome with the perioperative use of blood transfusion. This study aimed to establish the rate of anaemia identification, treatment and implications of this preoperative anaemia on ARBT use. Methods All patients who underwent elective surgery for colorectal cancer over 18 months at a single Tertiary Centre were reviewed. Electronic databases and patient casenotes were reviewed to yield required data. Results Complete data was available on 201 patients. 67% (n = 135) had haemoglobin tested at presentation. There was an inverse correlation between tumour size and initial haemoglobin (P < 0.01, Rs = −0.3). Initial haemoglobin levels were significantly lower in patients with right colonic tumours (P < 0.01). Patients who were anaemic preoperatively received a mean 0.91 units (95%CI 0–0.7) per patient which was significantly higher than non-anaemic patients (0.3 units [95%CI 0–1.3], P < 0.01). For every 1 g/dl preoperative haemoglobin increase, the likelihood of transfusion was reduced by approximately 40% (OR 0.57 [95%CI 0.458–0.708], P < 0.01). Laparoscopic surgery was associated with fewer anaemic patients transfused (P < 0.01). Conclusion Haemoglobin levels should be routinely checked at diagnosis of colorectal cancer, particularly those with large or right sided lesions. Early identification of anaemia allows initiation of treatment which may reduce transfusion risk even with modest haemoglobin rises. The correct treatment of this anaemia needs to be established.

Is there a role for intravenous iron therapy in patients undergoing colorectal cancer resection

Evaluation of: Titos-Arcos JC, Soria-Aledo V, Carrillo-Alcaraz A, Ventura-López M, Palacios-Muñoz S, Pellicer-Franco E. Is intravenous iron useful for reducing transfusions in surgically treated colorectal cancer patients? World J. Surg. 36(8), 1893–1897 (2012). Worldwide, colorectal cancer (CRC) is one of the most common forms of malignancy and is increasing in incidence in many regions. At diagnosis, approximately 40% of patients with CRC are anemic, a figure that increases over the course of a patient’s treatment due to many factors, including ongoing hemorrhage. Preoperative anemia is therefore associated with increased allogenic red blood cell transfusion (ARBT) rates. In the context of CRC, perioperative ARBT has been linked with adverse postoperative outcomes, including higher morbidity, mortality and cancer recurrence rates. Therefore, strategies to potentially reduce the need for ARBT have been the focus of several recent studies. We critically evaluate a recent paper that explores intravenous iron III sucrose as a treatment option for the management of postoperative anemia in CRC patients. This study is a retrospective, observational case-controlled study that was designed to evaluate whether the use of postoperative intravenous iron reduces the incidence of ARBT following CRC resection.

LAP-VEGaS Practice Guidelines for Reporting of Educational Videos in Laparoscopic Surgery: A Joint Trainers and Trainees Consensus Statement.

Objective: Consensus statement by an international multispecialty trainers and trainees expert committee on guidelines for reporting of educational videos in laparoscopic surgery. Summary of Background Data: Instructive laparoscopy videos with appropriate exposition could be ideal for initial training in laparoscopic surgery, but there are no guidelines for video annotation or procedural educational and safety evaluation. Methods: Delphi questionnaire of 45 statements prepared by a steering group and voted on over 2 rounds by committee members using an electronic survey tool. Committee selection design included representative surgical training experts worldwide across different laparoscopic specialties, including general surgery, lower and upper gastrointestinal surgery, gynecology and urology, and a proportion of aligned surgical trainees. Results: All 33 committee members completed both the first and the second round of the Delphi questionnaire related to 7 major domains: Video Introduction/Authors’ information; Patient Details; Procedure Description; Procedure Outcome; Associated Educational Content; Peer Review; and Use in Educational Curriculae. The 17 statements that did not reach at least 80% agreement after the first round were revised and returned into the second round. The committee consensus approved 37 statements to at least an 82% agreement. Conclusion: Consensus guidelines on how to report laparoscopic surgery videos for educational purposes have been developed. We anticipate that following our guidelines could help to improve video quality. These reporting guidelines may be useful as a standard for reviewing videos submitted for publication or conference presentation.

Development of a surgical trainer assessment questionnaire.

The assessment of surgical trainees has become well‐established in practice; however, this is not yet the case for surgical trainers. The aim of this study was to develop a trainer assessment questionnaire (OxTrAQ) based on the 12 key trainer attributes identified by a previous systematic review, to then explore this questionnaires potential domains and test its reliability.

PTU-113 Hepcidin does not predict response to iron therapy in pre-operative anaemia in patients with colorectal cancer

Introduction Hepcidin has a key role in systemic iron homeostasis. We assessed if serum hepcidin predicts response to either intravenous or oral iron therapy in the treatment of pre-operative anaemia. Method As part of the IVICA trial [1], patients with iron-deficiency anaemia undergoing elective surgery for colorectal cancer were randomised to receive oral ferrous sulphate (n=58) or intravenous Ferinject (n=54) for a minimum of two weeks before surgery. Blood samples were taken at recruitment (prior to iron therapy) and on the day of surgery (after iron therapy). Clinical data was collected prospectively. Changes in haemoglobin from recruitment to day of surgery were measured. Serum were analysed using an ELISA assay to determine hepcidin levels. Association between hepcidin levels and mean haemoglobin change from recruitment to day of surgery were tested using the Mann Whitney U test. High hepcidin was defined as >56 ng/ml. Results Both oral and intravenous iron groups were similar at baseline for recruitment haemoglobin (9.9 g/dL and 9.6 g/dL respectively, p=0.2). Median hepcidin levels were 1.9 ng/mL (range 0–86) in the oral iron group and 1.7 ng/mL (range 0–205 ng/mL) in the IV iron group. No correlation was found between hepcidin levels and haemoglobin change in either oral or intravenous groups. Mean haemoglobin change was similar for those with high hepcidin levels (1.14 g/dL) compared to low hepcidin levels (1.12 g/dL) with no statistical difference found (p=0.949). Subset analysis of oral and intravenous groups also showed no differences (p=0.679 and p=0.775 respectively). Conclusion In this study, neither absolute hepcidin nor high hepcidin levels>56 ng/ml predicted response to iron therapy, irrespective of the route of administration of iron therapy. Reference . Keeler BD, et al. Randomised clinical trial of preoperative oral versus intravenous iron in anaemic patients with colorectal cancer. Br J Surg, 2017;104(3):214–221. Disclosure of Interest None Declared

PTU-110 The use of pre-operative intravenous iron improves post-operative patient reported quality of life in anaemic colorectal cancer patients: results from a multicentre randomised controlled trial.

Introduction Anaemia is associated with multiple symptoms including fatigue which in turn can contribute to impaired quality of life. It is a common finding in colorectal cancer as a result of chronic insidious haemorrhage and impaired iron haemostasis. Consequently, colorectal cancer patients are at risk of the symptomatology of anaemia. Method Preoperative colorectal cancer patients (n=116) who were found to be anaemic (>1g/dL below the World Health Organisation definition) were randomised to receive either intravenous (IV) or oral iron. Quality of life (QOL) questionnaires were performed at; [i] recruitment, [ii] at least 14 days after iron therapy and [iii] post-operatively in the first outpatient follow-up. QOL assessments undertaken included the following; [a] Functional Assessment of Cancer Therapy-Anaemia (FACT-AN) [b] EuroQol EQ-5D-5L (EQ5D) and [c] modified Short-Form 36 (SF36) v1 questionnaires. Results Both groups were comparable in patient demographics, starting haemoglobin, operative details, tumour histology and time from recruitment to postoperative review (oral 101 days [IQR 62-193]; IV 91 days [IQR 61-135, P=0.98]. Despite homogeneity in all initial QOL scores at recruitment significant differences were evident between groups at outpatient review in the all bar two of the SF36 components including: General Health (Oral 64.79u [58.8-70.8]; IV 73.63u [68.4-78.8]; P<0.01), Vitality (Oral 60.49u [53.7-67.3]; IV 74.83u [69.2-80.5]; P<0.001). EQ5D scores for the visual analogue scale were also significantly higher in the IV group at outpatient review (OI 70.9u [65.1-76.8]; IV 82.53u [77.8-87.2]; P<0.001), with parity in the remaining 4 components. Furthermore, significant differences were evident in FACT-AN Total scores (Oral 148.3u [139-158];IV 166.1u [160-172.3]; P<0.01), FACT-AN Anaemia subscale scores (Oral 59.6u [54.4-64.8]; IV 69.1u [65.7-72.5]; P<0.01), Functional Well Being (Oral 20.2u [17.9-22.5]; IV 24.1u [22.2-26];P<0.01) and Emotional Well Being (Oral 19.9u [18.5-21.2]; IV 21.5u [20-23]; P<0.05) at outpatient review. None of the QOL measures had higher scores in the oral group. Conclusion Intravenous iron is more efficacious than oral iron at improving the post-operative quality of life of anaemic colorectal cancer patients. The usage of intravenous iron should be considered in patients who are found to have colorectal cancer during evaluation of anaemia by Gastroenterologists to optimise these outcomes. Disclosure of Interest: M. Brookes Conflict with: Vifor International, Conflict with: Vifor International, B Keeler: None Declared, O Ng: None Declared, H Padmanabhan: None Declared, A Simpson: None Declared, A Acheson Conflict with: Vifor International