Comparison of change in stored body iron and metabolic status after distal gastrectomy according to methods of reconstruction in patients with gastric cancer

Abstract

Background: 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 distal gastrectomy is closely associated with the reconstruction method, and determine the optimal reconstruction method after gastrectomy.Methods: Using a prospective gastric cancer database, we identified 311 patients with early gastric cancer with complete hematologic parameters who underwent distal gastrectomy between January 2004 and May 2008. Kaplan-Meier methods, Cox regression, and logistic regression were used to evaluate the associations of the reconstruction method with iron metabolism.Results: The prevalence of iron-deficiency 3 years after distal gastrectomy was 64.0%, and iron-deficiency anemia was observed in 26.4% of patients. Iron-deficiency developed in 58.3% and 79.5% of patients after gastroduodenostomy and gastrojejunostomy within 3 years after surgery (P=0.001), respectively. Iron-deficiency was significantly more frequent in women than in men (P=0.0001) and after gastrojejunostomy than after gastroduodenostomy (P=0.0003). Serum ferritin levels were different according to the reconstruction method after distal gastrectomy.Conclusion: Iron-deficiency occurs in most gastric cancer patients after distal gastrectomy, and its incidence was different according to reconstruction method. To improve iron metabolism after distal gastrectomy, gastroduodenostomy would be the method of reconstruction whenever possible.