Jeong Oh, Park Young Kyu, Ryu Seong Yeop
Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea.
J Korean Surg Soc. 2012 Feb;82(2):79-86. doi: 10.4174/jkss.2012.82.2.79. Epub 2012 Jan 27.
Postsurgical anemia is one of the common unpleasant postoperative sequels during the early postoperative period after gastrectomy, for which no standard care has been established. To facilitate proper management, we investigated the clinical features of postsurgical anemia and sought to identify the factors affecting its subsequent recovery.
A retrospective review of 406 consecutive gastric cancer patients who underwent gastrectomy without systemic chemotherapy between August 2008 and September 2009. Clinical courses of postsurgical anemia were monitored at 3, 6, and 12 months post-surgery. Clinicopathological factors affecting recovery of postsurgical anemia were analyzed using a multivariate logistic regression model.
The study subjects consisted of 265 males and 141 females (mean age, 61.8 years). After operation, 318 (78.3%) presented with postsurgical anemia, and 217 (66.7%) and 47 (11.6%) had mild or moderate anemia, respectively, at the time of discharge. During the follow-up, 173 (54.4%) of the 318 with postsurgical anemia showed a spontaneous recovery at 3 months post-surgery, but no significant changes were observed in postsurgical anemia at 6 or 12 months post-surgery. Univariate and multivariate analysis revealed that old age (≥60 years), preoperative anemia, anemia severity (moderate anemia), and total gastrectomy were independent factors that adversely affect the spontaneous recovery of post-surgical anemia after gastrectomy.
Proper intervention may be required for postsurgical anemia that does not achieve a spontaneous recovery until postoperative 3 months. However, proper management, such as the use of iron or the best route for iron supplementation, needs to be evaluated in future clinical trials.
术后贫血是胃切除术后早期常见的不良术后后遗症之一，目前尚未确立标准的治疗方法。为便于进行恰当的管理，我们对术后贫血的临床特征进行了调查，并试图确定影响其后续恢复的因素。
对2008年8月至2009年9月期间连续406例行胃切除术且未接受全身化疗的胃癌患者进行回顾性研究。在术后3、6和12个月监测术后贫血的临床病程。使用多因素逻辑回归模型分析影响术后贫血恢复的临床病理因素。
研究对象包括265例男性和141例女性（平均年龄61.8岁）。术后，318例（78.3%）出现术后贫血，出院时分别有217例（66.7%）和47例（11.6%）患有轻度或中度贫血。在随访期间，318例术后贫血患者中有173例（54.4%）在术后3个月时出现自发恢复，但在术后6个月或12个月时术后贫血未见明显变化。单因素和多因素分析显示，老年（≥60岁）、术前贫血、贫血严重程度（中度贫血）和全胃切除术是对胃切除术后手术性贫血的自发恢复产生不利影响的独立因素。
对于术后3个月仍未实现自发恢复的术后贫血，可能需要进行适当干预。然而，未来的临床试验需要评估适当的管理方法，如铁剂的使用或最佳补铁途径。
