Anemia after gastrectomy for early gastric cancer: Long-term follow-up observational study

Abstract

AIM:To identify the incidence and etiology of anemia after gastrectomy in patients with long-term follow-up after gastrectomy for early gastric cancer. METHODS:The medical records of those patients with early gastric adenocarcinoma who underwent curative gastrectomy between January 2006 and October 2007 were reviewed. Patients with anemia in the preoperative workup, cancer recurrence, undergoing systemic chemotherapy, with other medical conditions that can cause anemia, or treated during follow up with red cell transfusions or supplements for anemia were excluded. Anemia was defined by World Health Organization criteria (Hb < 12 g/dL in women and < 13 g/dL in men). Iron deficiency was defined as serum ferritin < 20 μg/dL. Vitamin B12 deficiency was defined as serum vitamin B12 < 200 pg/mL. Iron deficiency anemia was defined as anemia with concomitant iron deficiency. Anemia from vitamin B12 deficiency was defined as megaloblastic anemia (mean cell volume > 100 fL) with vitamin B12 deficiency. The profile of anemia over 48 mo of follow-up was analyzed. RESULTS:One hundred sixty-one patients with gastrectomy for early gastric cancer were analyzed. The incidence of anemia was 24.5% at 3 mo after surgery and increased up to 37.1% at 48 mo after surgery. The incidence of iron deficiency anemia increased during the follow up and became the major cause of anemia at 48 mo after surgery. Anemia of chronic disease and megaloblastic anemia were uncommon. The incidence of anemia in female patients was significantly higher than in male patients at 12 (40.0% vs 22.0%, P = 0.033), 24 (45.0% vs 25.0%, P = 0.023), 36 (55.0% vs 28.0%, P = 0.004), and 48 mo (52.0% vs 31.0%, P = 0.022) after surgery. Patients with total gastrectomy showed significantly higher incidence of anemia than patients with subtotal gastrectomy at 48 mo after surgery (60.7% vs 31.3%, P = 0.008). The incidence of iron deficiency was significantly higher in female patients than in male patients at 6 (35.4% vs 13.3%, P = 0.002), 12 (45.8% vs 16.8%, P < 0.001), 18 (52.1% vs 22.3%, P < 0.001), 24 (60.4% vs 20.9%, P < 0.001), 36 (62.5% vs 29.2%, P < 0.001), and 48 mo (66.7% vs 34.7%, P = 0.001) after surgery. CONCLUSION:Anemia was frequent after gastrectomy for early gastric cancer, with iron deficiency being the major cause. Evaluation for anemia including iron status should be performed after gastrectomy and appropriate iron replacement should be considered.

Efficacy of Long-Term Oral Vitamin B12 Supplementation after Total Gastrectomy: Results from a Prospective Study

“…A long-term follow-up study showed that anemia was common after gastrectomy and increased from 25% at 3 months to 37% at 48 months after surgery, iron deficiency being the major cause [1]. In our study, the incidence of anemia was lower and decreased during follow-up, showing that a close monitoring and appropriate nutritional supplementation can easily prevent the incidence of anemia after gastrectomy.…”

“…Anemia is a frequent complication after total gastrectomy, and deficiencies of iron, VB12, or folate, either alone or in combination, are also common during follow-up [1,12]. Impaired iron absorption is explained by the following mechanisms: bypass of the duodenum, increased intestinal transit time and reduction in gastric acid which is necessary for the absorption of food iron [3].…”

“…VB12 deficiency can develop as early as 1 year after total gastrectomy even before the onset of anemia [1,14], and it should be routinely prescribed in this group of patients [8]. The standard treatment of VB12 deficiency has been parenteral administration, usually by IM injection, under the form of cyanocobalamin, hydroxocobalamin, or methylcobalamin [15,16].…”

“…Anemia is a frequent complication after total gastrectomy, and deficiencies of iron, vitamin B 12 (VB12) or folate, either alone or in combination, are common after the surgical procedure [1]. Notably, VB12 deficiency, which causes megaloblastic anemia and a spectrum of neuropsychiatric disorders, is one of the common long-term nutritional sequelae after total gastrectomy [2].…”

Micronutrient Deficiencies Following Minimally Invasive Esophagectomy for Cancer

“…In bariatric [13][14][15][16][17] and gastric cancer surgery [18][19][20][21], it has been shown that new micronutrient deficiencies may develop on the long-term or pre-existent deficiencies worsen postoperatively in a considerable number of patients. This effect was most prominent following bariatric Roux-en-Y gastric bypass surgery and total gastrectomy for cancer with Roux-en-Y esophagojejunostomy.…”