Brief Article
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World J Gastroenterol. Feb 21, 2014; 20(7): 1852-1857
Published online Feb 21, 2014. doi: 10.3748/wjg.v20.i7.1852
Intravenous iron supplementation may be superior to observation in acute isovolemic anemia after gastrectomy for cancer
Hong Man Yoon, Young-Woo Kim, Byung Ho Nam, Daniel Reim, Bang Wool Eom, Ji Yeon Park, Keun Won Ryu
Hong Man Yoon, Young-Woo Kim, Daniel Reim, Bang Wool Eom, Ji Yeon Park, Keun Won Ryu, Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang-si 410-769, South Korea
Byung Ho Nam, Cancer Registration and Biostatistics Branch and Center for Clinical Trials, National Cancer Center, Goyang-si 410-769, South Korea
Ji Yeon Park, Department of Surgery, Soon Chun Hyang University Hospital, Seoul 140-743, South Korea
Author contributions: Kim YW designed reseach; Yoon HM, Park JY and Eom BW performed research; Nam BH and Ryu KW analyzed data; Yoon HM, Kim YW and Reim D wrote the paper.
Correspondence to: Young-Woo Kim, MD, Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, 809 Madu-dong, Ilsandong-gu, Goyang-si 410-769, South Korea. gskim@ncc.re.kr
Telephone: +82-31-9201635 Fax: +82-31-9200696
Received: August 5, 2013
Revised: November 20, 2013
Accepted: December 12, 2013
Published online: February 21, 2014
Abstract

AIM: To determine whether the application of post-operative intravenous (IV)-iron for acute isovolemic anemia after gastrectomy for cancer may be effective.

METHODS: Among 2078 gastric cancer patients who underwent surgery between February 2007 and August 2009 at the National Cancer Center Korea, 368 patients developed post-operative anemia [hemoglobin-(Hb)-level < 9 g/dL] within the first postoperative week. Patients requiring transfusions were excluded. IV-iron was administered to 63 patients (iron group). Sixty patients were observed without treatment (observation group). The clinical outcomes of the groups were compared concerning clinicopathologic data, morbidity, and changes in Hb levels using Fisher’s exact test, Student’s t-test and the Z-test.

RESULTS: The initial Hb level was higher in the iron group than in the observation group (7.3 ± 1.0 g/dL vs 8.4 ± 0.5 g/dL, P < 0.001). The slope of the changes in the Hb level was significantly higher in the iron group than in the observation group (0.648 ± 0.054 vs 0.349 ± 0.038, P < 0.001). The Hb level 1 and 3 mo post-operatively increased from 10.7 ± 1.3 to 11.9 ± 1.3 g/dL in the iron group (P = 0.033) and from 10.1 ± 1.0 to 10.8 ± 1.4 g/dL in the observation group (P < 0.001). The postoperative hospital stay was significantly longer in the iron group than in the observation group (10.5 ± 6.8 d vs 7.6 ± 5.5 d, P = 0.011). There were no significant differences in the major and surgical complications between the groups (6.3% vs 13.3%, P = 0.192; 9.5% vs 3.3%, P = 0.164).

CONCLUSION: IV-iron supplementation may be an effective treatment for post-operative isovolemic post-gastrectomy anemia and may be a better alternative than observation.

Keywords: Intravenous iron, Observation, Gastric cancer, Acute isovolemic anemia, Gastrectomy

Core tip: Acute isovolemic anemia frequently occurs after major surgery. Intravenous iron supplementation was more effective in elevating the hemoglobin level than observation, and the complications were comparable to observation in 123 acute post-gastrectomy anemia patients.