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

Norbeck, Anna LU ; Asp, Mihaela LU orcid ; Malander, Susanne LU orcid and Kannisto, Päivi LU (2026) In European Journal of Surgical Oncology
Abstract
Background
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.
Methods
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... (More)
Background
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.
Methods
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.
Results
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.
Conclusion
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. (Less)
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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Ovarian cancer, intravenous iron, Anemia
in
European Journal of Surgical Oncology
article number
111390
publisher
Elsevier
ISSN
1532-2157
DOI
10.1016/j.ejso.2026.111390
language
English
LU publication?
yes
id
7e370f2d-25dd-4bb8-b342-49376572a217
date added to LUP
2026-01-06 09:47:05
date last changed
2026-01-07 09:23:30
@article{7e370f2d-25dd-4bb8-b342-49376572a217,
  abstract     = {{Background<br/>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.<br/>Methods<br/>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) &lt; 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.<br/>Results<br/>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.<br/>Conclusion<br/>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.}},
  author       = {{Norbeck, Anna and Asp, Mihaela and Malander, Susanne and Kannisto, Päivi}},
  issn         = {{1532-2157}},
  keywords     = {{Ovarian cancer; intravenous iron; Anemia}},
  language     = {{eng}},
  month        = {{01}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Surgical Oncology}},
  title        = {{Iron deficiency restrains short-term recovery in patients undergoing surgery for advanced ovarian cancer}},
  url          = {{http://dx.doi.org/10.1016/j.ejso.2026.111390}},
  doi          = {{10.1016/j.ejso.2026.111390}},
  year         = {{2026}},
}