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Int J Colorectal Dis. 2017 Feb;32(2):223-232. doi: 10.1007/s00384-016-2678-3. Epub 2016 Oct 21.

Preoperative anaemia and perioperative red blood cell transfusion as prognostic factors for recurrence and mortality in colorectal cancer-a Swedish cohort study.

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Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Functional Area of Emergency Medicine Huddinge, C1:63, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Center of Digestive Diseases, P9:03, Karolinska University Hospital, Solna, Sweden.
Department of Surgical and Perioperative Sciences, Umeå university, Umeå, Sweden.



The hypothesis in this study was that anaemia prior to surgery and perioperative red blood cell transfusion increases the risk for recurrence and overall mortality in patients with stages I-III colorectal cancer after abdominal resection with curative intent.


This is a Swedish single centre retrospective cohort study. Data on 496 consecutive radical abdominal resections stages I-III colorectal cancer performed at the Karolinska University Hospital 2007-2010 were extracted from the Swedish Colorectal Cancer Registry. Data were linked to local laboratory and transfusion databases to identify preoperative anaemia and perioperative transfusion. Disease recurrence was validated by scrutiny of patient records. A total of 496 stages I-III colorectal cancer patients were included in the analysis. Multivariate Cox regression analysis adjusted for tumour and patient characteristics were performed to assess risk for recurrence and overall mortality.


Anaemia prior to surgery was associated with increased risk for overall mortality (HR 2.1, 95% CI 1.4-3.2). There was no association between anaemia and risk for recurrence (HR 1.6, 95% CI 0.97-2.6). Transfusion was not associated with increased risk of recurrence (HR 0.7, 95% CI 0.4-1.3) or overall mortality (HR 1.04, 95% CI 0.7-1.6).


Anaemia prior to colorectal cancer surgery was associated with increased risk for overall mortality while a no increased risk was seen for recurrence. Previous findings indicating an association between blood transfusion and increased risk for recurrence could not be confirmed.


Anaemia; Colorectal cancer; Mortality; Recurrence; Survival; Transfusion

[Indexed for MEDLINE]
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Conflict of interest statement

Compliance with ethical standards All procedures performed in studies were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethics approval was obtained from the Regional Ethics Committee in Stockholm (2012/784-31/1, 2014/354-32, and 2014/950-32). Informed consent was obtained from the participants when entered into the SCRCR. Conflict of interest The authors declare that they have no conflicts of interest. Grants were received from The Bengt Ihre Foundation (SLS-247641 and SLS-327911) and ALF funding (SLL 20120046 and SLL 20130164). M Mörner received a scholarship from The Swedish Society of Medicine SLS-512621 covering costs for the travel to Denmark during MASCC 2015. Podium Abstract at MASCC, Copenhagen, Denmark, June 25–27, 2015. Oral presentation 2015-06-26.

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