Iron deficiency restrains short-term recovery in patients undergoing surgery for advanced ovarian cancer

Patients with advanced ovarian cancer (AOC) who undergo primary and interval debulking surgery are often anemic at diagnosis, with iron deficiency being the most common cause. The aim was to investigate whether preoperative anemia and iron deficiency impact short-term recovery.

This retrospective cohort study included 262 patients with AOC who underwent surgery at Skane University Hospital Lund, Sweden, between January 2020 and December 2023. Patients were divided into four groups, according to preoperative anemia and iron deficiency. Iron deficiency was defined as transferrin saturation (TSAT) < 0.20. Severe complications were defined as Clavien-Dindo (CD) grade ≥3. Logistic regression analyses were used to investigate the difference between patients with and without iron deficiency.

Among patients with iron deficiency anemia, 24 % of patients had more than 1 cm of residual tumor at the end of surgery, compared to 6-8 % of patients with no anemia and/or no iron deficiency, (p 0.005). The rate of severe complications (CD ≥ 3) was higher for patients with iron deficiency, odds ratio 2.47 (95 % CI 1.11-5.50), than for patients with no iron deficiency, adjusted for the Aletti score, operating time and hemoglobin (Hb) level. There was no difference between groups regarding length of hospital stay.

Patients with iron deficiency anemia, were less likely to undergo radical or optimal surgery. Severe postoperative complications were more common in patients with iron deficiency, with or without anemia. These analyses indicate that iron deficiency is associated with more advanced disease and complex surgical procedures.