Introduction The management of oesophageal cancer (OC) has evolved significantly in the last decade with MAGIC regimen chemotherapy and the increasing utilisation of minimally invasive techniques. Despite this, anaemia remains a common problem.
This study examines how changes in the treatment of OC have impacted upon anaemia and blood transfusions, comparing two groups almost a decade apart.
Method We conducted a retrospective review of patients diagnosed with OC from 2003–04 and 2012–13. Data on demographics, site and histology, TNM staging, treatment, pre-operative haemoglobin (Hb), rates of allogeneic blood transfusion and units cross matched were recorded.
Results A total of 285 patients underwent oesophagectomy, 2003–04 (n = 145) and 2012–13 (n = 140). Patients were similar in age, sex, site of malignancy and histology. Patients in 2003–04 had more advanced disease at time of surgery (p < 0.05) with TNM stage 3 disease in 55.9% (n = 81) vs. 42.1% (n = 59). This likely reflects down-staging from neoadjuvant chemotherapy with 41.1% (44/107) receiving neoadjuvant chemotherapy in 2003–04 vs. 55.7% (68/112) of patients in 2012–13 (p < 0.05). Furthermore, those receiving chemotherapy mainly received the MAGIC regimen in the 2012–13 series whilst in 2003–4 the patients would have received 2 cycles of Cisplatin and 5 FU as per the OE-02 regimen.
Mean pre-operative Hb was similar in 2003–04 to 2012–13, 12.9 g/dL (SD 1.7) vs 12.3 g/dL (SD1.7), p = 0.416. However, in those who had neoadjuvant chemotherapy, Hb was significantly different (p < 0.05), 13.7 g/dL (SD 1.9) vs 12.2 g/dL (SD 1.7) from 2003–04 to 2012–2013.
Consequently, patients in 2012–13 were significantly more likely to be anaemic pre-operatively (62.9% vs 38%, p < 0.01), and rates more pronounced if only adenocarcinoma are analysed (65.2% vs 34.6%, p < 0.01). There were also trends towards more transfusion in 2012–13 (60% vs 49%, p = 0.06) and more blood per patient 2.5u vs 2.2u, although these did not reach significance.
No patients in 2003–04 had a laparoscopically assisted operation compared to 23 (16.4%) in 2012–13. 11/23 were transfused (47.8%) compared to 73/117 who received open procedures (62.4%).
Conclusion Changes in the treatment of OC have increased the frequency of anaemia seen pre-operatively for patients undergoing elective oesophageal resections. This is likely due to MAGIC regimen neoadjuvant chemotherapy. While the benefits of MAGIC are recognised, peri-operative anaemia has implications on both morbidity and mortality. We now need to look at strategies to improve operative outcomes further by targeting this anaemia for treatment.
Disclosure of interest None Declared.
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