Brief Article
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World J Gastroenterol. Nov 14, 2012; 18(42): 6114-6119
Published online Nov 14, 2012. doi: 10.3748/wjg.v18.i42.6114
Anemia after gastrectomy for early gastric cancer: Long-term follow-up observational study
Chul-Hyun Lim, Sang Woo Kim, Won Chul Kim, Jin Soo Kim, Yu Kyung Cho, Jae Myung Park, In Seok Lee, Myung-Gyu Choi, Kyo-Young Song, Hae Myung Jeon, Cho-Hyun Park
Chul-Hyun Lim, Sang Woo Kim, Won Chul Kim, Jin Soo Kim, Yu Kyung Cho, Jae Myung Park, In Seok Lee, Myung-Gyu Choi, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul 137-701, South Korea
Kyo-Young Song, Hae Myung Jeon, Cho-Hyun Park, Department of Surgery, The Catholic University of Korea College of Medicine, Seoul 137-701, South Korea
Author contributions: Lim CH, Kim SW and Kim WC designed the research; Lim CH, Kim SW, Kim WC, Kim JS, Cho YK, Park JM, Lee IS, Choi MG, Song KY, Jeon HM and Park CH performed the research; Lim CH and Kim SW analyzed the data; and Lim CH wrote the paper.
Correspondence to: Sang Woo Kim, MD, PhD, Department of Internal Medicine, The Catholic University of Korea College of Medicine, No. 505 Banpo-Dong, Seocho-Gu, Seoul 137-701, South Korea. viper@catholic.ac.kr
Telephone: +82-2-22586021 Fax: +82-2-22582055
Received: July 27, 2012
Revised: September 20, 2012
Accepted: September 29, 2012
Published online: November 14, 2012
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.

Keywords: Gastrectomy; Stomach neoplasms; Anemia; Iron deficiency; Vitamin B12 deficiency