• Joong Ho Lee, Woo Jin Hyung, Hyoung-Il Kim, Yoo-Min Kim, Taeil Son, Naoki Okumura, Yanfeng Hu, Choong-Bai Kim, and Sung Hoon Noh.
• *Department of Surgery and †Brain Korea 21 Project for Medical Science, Yonsei University Health System, Seoul, Korea ‡Robot and MIS center, Severance Hospital, Yonsei University Health System, Seoul, Korea §Department of Surgical Oncology, Gifu University School of Medicine, Gifu, Japan ¶Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China.
• Ann. Surg. 2013 Dec 1; 258 (6): 964-9.

ObjectiveAnemia 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 MethodsUsing 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.ResultsThe 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).ConclusionsIron 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.

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