Iron Metabolism After Gastrectomy for Gastric Cancer
Iron Metabolism After Gastrectomy for Gastric Cancer
Objective: Anemia after gastrectomy is commonly neglected by clinicians despite being an important and frequent long-term metabolic sequela. We hypothesized that the incidence and timing of the occurrence of iron deficiency after gastrectomy is closely associated with the extent of gastrectomy and the reconstruction method, and we investigated the treatment outcomes of iron supplementation to understand iron metabolism and determine the optimal reconstruction method after gastrectomy.
Patients and Methods: Using a prospective gastric cancer database, we identified 381 patients with early gastric cancer with complete hematologic parameters who underwent gastrectomy between January 2004 and May 2008. Kaplan-Meier methods, Cox regression, and logistic regression were used to evaluate the associations of the extent of gastrectomy and reconstruction method with iron metabolism.
Results: The prevalence of iron deficiency 3 years after gastrectomy was 69.1%, and iron-deficiency anemia was observed in 31.0% of patients. Iron deficiency developed in 64.8% and 90.5% of patients after distal gastrectomy and total gastrectomy within 3 years after surgery (P < 0.0001), respectively. Iron deficiency was significantly more frequent in women than in men (P < 0.0001) and after gastrojejunostomy than after gastroduodenostomy (P < 0.0001). Serum ferritin levels were different according to the extent of gastrectomy and reconstruction method. The proportion of patients treated for iron-deficiency anemia was also significantly different according to the extent of gastrectomy (P = 0.020).
Conclusions: Iron deficiency occurs in most patients with gastric cancer after gastrectomy, and its incidence was different according to the extent of gastrectomy and reconstruction method. To improve iron metabolism after distal gastrectomy, gastroduodenostomy would be the method of reconstruction whenever possible.
Gastric cancer remains a major health issue and one of the leading causes of cancer death worldwide although the incidence and mortality of gastric cancer have gradually decreased. In East Asia, especially in Korea and Japan, nationwide mass screening programs have improved the survival of patients with gastric cancer through early detection. The improved survival of patients with gastric cancer has increased the interest of highly motivated surgeons in the quality of life of patients after surgical treatment.
Anemia is highly associated with impaired quality of life and performance status in patients with cancer. Anemia also has the potential to adversely affect the therapeutic efficacy and survival of patients with cancer because it compromises the efficacy of radiotherapy and the response to chemotherapy. Anemia after gastrectomy is commonly neglected by clinicians despite being an important long-term metabolic sequela with high prevalence. Anemia after gastrectomy is caused by various mechanisms and most cases of anemia in gastrectomized patients are due to iron deficiency, abnormal vitamin B12 metabolism, or both. Iron-deficiency anemia is more common than vitamin B12 deficiency anemia in patients after gastrectomy. Iron deficiency after gastrectomy is primarily caused by decreased iron absorption due to reduced food intake and bypass of the duodenum in some methods of reconstruction.
However, identifying individuals with iron deficiency or iron-deficiency anemia after gastrectomy is difficult because the symptoms are vague and nonspecific, and physicians focus only on improving the survival of these patients with cancer. Previous studies of iron deficiency after gastrectomy were performed a half-century ago with small study populations. Moreover, most studies did not regularly examine hematologic and nutritional profiles related to iron deficiency. To our knowledge, the influence of the extent of gastrectomy and method of reconstruction on iron metabolism has never been explored thoroughly.
We hypothesized that the incidence of iron deficiency, based on physiological changes after gastrectomy, is closely associated with the extent of gastrectomy and method of reconstruction. To assess the influence of the extent of gastrectomy and method of reconstruction, we compared the iron and nutritional profiles of patients who underwent gastrectomy in a database of patients with gastric cancer. We also evaluated the efficacy of iron supplementation to shed light on iron metabolism and determine the optimal reconstruction method after gastrectomy.
Abstract and Introduction
Abstract
Objective: Anemia after gastrectomy is commonly neglected by clinicians despite being an important and frequent long-term metabolic sequela. We hypothesized that the incidence and timing of the occurrence of iron deficiency after gastrectomy is closely associated with the extent of gastrectomy and the reconstruction method, and we investigated the treatment outcomes of iron supplementation to understand iron metabolism and determine the optimal reconstruction method after gastrectomy.
Patients and Methods: Using a prospective gastric cancer database, we identified 381 patients with early gastric cancer with complete hematologic parameters who underwent gastrectomy between January 2004 and May 2008. Kaplan-Meier methods, Cox regression, and logistic regression were used to evaluate the associations of the extent of gastrectomy and reconstruction method with iron metabolism.
Results: The prevalence of iron deficiency 3 years after gastrectomy was 69.1%, and iron-deficiency anemia was observed in 31.0% of patients. Iron deficiency developed in 64.8% and 90.5% of patients after distal gastrectomy and total gastrectomy within 3 years after surgery (P < 0.0001), respectively. Iron deficiency was significantly more frequent in women than in men (P < 0.0001) and after gastrojejunostomy than after gastroduodenostomy (P < 0.0001). Serum ferritin levels were different according to the extent of gastrectomy and reconstruction method. The proportion of patients treated for iron-deficiency anemia was also significantly different according to the extent of gastrectomy (P = 0.020).
Conclusions: Iron deficiency occurs in most patients with gastric cancer after gastrectomy, and its incidence was different according to the extent of gastrectomy and reconstruction method. To improve iron metabolism after distal gastrectomy, gastroduodenostomy would be the method of reconstruction whenever possible.
Introduction
Gastric cancer remains a major health issue and one of the leading causes of cancer death worldwide although the incidence and mortality of gastric cancer have gradually decreased. In East Asia, especially in Korea and Japan, nationwide mass screening programs have improved the survival of patients with gastric cancer through early detection. The improved survival of patients with gastric cancer has increased the interest of highly motivated surgeons in the quality of life of patients after surgical treatment.
Anemia is highly associated with impaired quality of life and performance status in patients with cancer. Anemia also has the potential to adversely affect the therapeutic efficacy and survival of patients with cancer because it compromises the efficacy of radiotherapy and the response to chemotherapy. Anemia after gastrectomy is commonly neglected by clinicians despite being an important long-term metabolic sequela with high prevalence. Anemia after gastrectomy is caused by various mechanisms and most cases of anemia in gastrectomized patients are due to iron deficiency, abnormal vitamin B12 metabolism, or both. Iron-deficiency anemia is more common than vitamin B12 deficiency anemia in patients after gastrectomy. Iron deficiency after gastrectomy is primarily caused by decreased iron absorption due to reduced food intake and bypass of the duodenum in some methods of reconstruction.
However, identifying individuals with iron deficiency or iron-deficiency anemia after gastrectomy is difficult because the symptoms are vague and nonspecific, and physicians focus only on improving the survival of these patients with cancer. Previous studies of iron deficiency after gastrectomy were performed a half-century ago with small study populations. Moreover, most studies did not regularly examine hematologic and nutritional profiles related to iron deficiency. To our knowledge, the influence of the extent of gastrectomy and method of reconstruction on iron metabolism has never been explored thoroughly.
We hypothesized that the incidence of iron deficiency, based on physiological changes after gastrectomy, is closely associated with the extent of gastrectomy and method of reconstruction. To assess the influence of the extent of gastrectomy and method of reconstruction, we compared the iron and nutritional profiles of patients who underwent gastrectomy in a database of patients with gastric cancer. We also evaluated the efficacy of iron supplementation to shed light on iron metabolism and determine the optimal reconstruction method after gastrectomy.
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