Ann Surg Treat Res.  2023 Aug;105(2):82-90. 10.4174/astr.2023.105.2.82.

Efficacy of ferric carboxymaltose in iron deficiency anemia patients scheduled for pancreaticoduodenectomy

  • 1Department of General Surgery, Osan Hankook Hospital, Osan, Korea
  • 2Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
  • 3Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
  • 4Center for Gastric Cancer, National Cancer Center, Goyang, Korea
  • 5Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea


Perioperative transfusion is reported to be an independent risk factor not only for postoperative complications but also for early recurrence of periampullary carcinoma after pancreaticoduodenectomy (PD). The purpose of this study was to evaluate the safety and efficacy of ferric carboxymaltose (FCM) in reducing the need for perioperative transfusion in iron deficiency anemia patients scheduled for PD.
Twenty-two male patients (hemoglobin [Hb] 7 to <13 g/dL) and 18 female patients (Hb 7 to <12 g/dL) were enrolled in the study group and administered FCM 1–3 weeks before PD. The perioperative transfusion rate was the primary endpoint; morbidity, length of postoperative hospital stay, change in hematological parameters after FCM injection, and adverse effects of FCM were also investigated.
The perioperative transfusion rate of the study group was 22.5% (9 of 40). Hb level was significantly higher on the day of the operation compared to baseline (P < 0.001). Levels of Hb, transferrin saturation, and ferritin were higher at the follow-up compared to baseline (P = 0.008, P = 0.033, and P < 0.001, respectively).
FCM administration was associated with a reduced need for perioperative transfusion and can safely stabilize hematological parameters.


Preoperative anemia; Ferric carboxymaltose; Hematological tests; Pancreaticoduodenectomy; Perioperative transfusion rate


  • Fig. 1 Flow chart of the study. CBD, common bile duct; HPD, hepatopancreaticoduodenectomy.

  • Fig. 2 Change of hematological parameters in the study group. (A) Hemoglobin (Hb) level change. Total Hb level significantly increased from baseline to operation day (P < 0.001) and also increased, but not significantly from operation day to follow-up 4 to 6 weeks later (P = 0.373). It finally increased from baseline to follow-up 4 to 6 weeks later (P = 0.008). Hb levels of patients with levels lesser than 10 maintained significantly higher in the follow-up period than in the baseline. Hb levels were compared using paired t-test. (B) Transferrin saturation (TSAT) level change. TSAT significantly increased on operation day after the administration of ferric carboxymaltose (FCM) (P < 0.001), but decreased 4 to 6 weeks later (P < 0.001). However, it maintained a significantly higher state at the follow-up period compared to the levels at baseline (P = 0.033). TSAT levels were compared using Wilcoxon signed-rank test. (C) Ferritin level change. Ferritin level also significantly increased at operation day after the administration of FCM (P < 0.001), but decreased 4 to 6 weeks later (P < 0.001). However, it maintained a significantly higher state at the follow-up period compared to the levels at baseline (P < 0.001). Ferritin levels were compared using Wilcoxon signed-rank test.


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