The prevalence and clinical significance of postgastrectomy anemia in patients with early-stage gastric cancer: A retrospective cohort study

Abstract Background This study explored the cumulative incidence of anemia after gastrectomy in patients with early-stage gastric cancer and evaluated the relationship between postgastrectomy anemia and nutritional factors during long-term follow-up. Methods The medical records of patients with stage I gastric cancer who underwent curative gastrectomy between January 2006 and December 2013 were reviewed retrospectively. Hematologic parameters like hemoglobin, iron, ferritin, and vitamin B 12 level were obtained prior to and after surgery with other nutritional parameters such as total protein, albumin, total cholesterol, triglyceride, calcium, and phosphate. Postoperative follow-up was conducted at 6 months after surgery and then annually for 5 years. Results Among 566 patients who did not have anemia preoperatively, 240 (42.4%) experienced anemia at least once during the 5 years after gastrectomy. These 240 patients (the anemia group) showed lower preoperative levels of hemoglobin, iron, ferritin, and triglyceride than those of the patients who did not experience anemia (the normal group). Total gastrectomy, advanced T stage, and lymph node metastasis were significantly more common in the anemia group compared with the normal group. During long-term follow-up, the anemia group showed significantly lower serum levels of nutritional markers, especially triglycerides, compared with the normal group. The overall survival rate was significantly lower in the anemia group than in the normal group. Conclusions Anemia was common among gastric cancer patients after gastrectomy. Total gastrectomy and advanced T stage were identified as independent risk factors for postgastrectomy anemia. In addition, anemia might be associated with nutritional problems and a poor prognosis. Thus, regular monitoring and appropriate management of postgastrectomy anemia are important for early-stage gastric cancer patients with a long life expectancy.