Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Hepato-biliary and Pancreas Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
BMC Surg. 2023 Oct 12;23(1):308. doi: 10.1186/s12893-023-02217-x.
In pancreaticoduodenectomy (PD), the duodenum and upper jejunum responsible for iron absorption are removed, which can lead to massive hemorrhage during surgery and cause iron deficiency anemia after PD. The aim of this study was to evaluate overall changes in hematologic profiles of patients who underwent pancreaticoduodenectomy. Effect of preoperative intravenous iron treatment on recovery of anemia after surgery was also investigated.
From March 2021 to December 2021, patients who underwent curative PD at our institution due to periampullary lesions were enrolled. They were divided into two groups according to whether or not iron was administered before surgery. In the IV iron group, all patients had been routinely administered with 1000 mg of ferric carboxymaltose intravenously once about 3-7 days before the operation day. Contrarily, patients in the control group did not receive intravenous iron before PD. Changes in hematological profile were measured preoperatively and at 5, 14, and 30 days postoperatively. Clinical results of the two groups were compared and analyzed. Additionally, a subgroup analysis was performed for selected non-anemic patients who had preoperative hemoglobin level of 12.0 g/dl or higher to compare changes in hematologic profiles between the two groups.
Thirty patients of the IV iron group and 34 patients of the control group were analyzed. Although no difference was observed in postoperative complications or mortality, hemoglobin and iron levels were recovered significantly faster at two weeks postoperatively in the IV iron group than in the control group. Iron levels were significantly higher in the IV iron group throughout the postoperative period. In subgroup analysis conducted for non-anemic patients, hemoglobin levels were recovered significantly faster and maintained higher in the IV iron group throughout the postoperative period, although baseline levels of hemoglobin were similar between the two groups. In addition, the length of intensive care unit stay was significantly shorter in the IV iron group than in the control group.
Preoperative intravenous iron treatment might be effective in facilitating recovery of hematologic profiles of patients during the recovery period after PD regardless of the presence of preoperative anemia, thus preventing postoperative iron deficiency anemia.
在胰十二指肠切除术（PD）中，负责铁吸收的十二指肠和上段空肠被切除，这可能导致手术过程中大量出血，并在 PD 后导致缺铁性贫血。本研究旨在评估接受胰十二指肠切除术的患者的血液学特征的总体变化。还研究了术前静脉补铁对术后贫血恢复的影响。
2021 年 3 月至 2021 年 12 月，因壶腹周围病变在我院接受根治性 PD 的患者入组。根据是否在术前给予铁剂，将他们分为两组。在 IV 铁组中，所有患者在手术前约 3-7 天常规给予 1000mg 羧基麦芽糖铁静脉注射一次。相反，PD 前对照组患者未给予静脉铁。测量术前和术后 5、14 和 30 天的血液学特征变化。比较分析两组的临床结果。此外，对术前血红蛋白水平为 12.0g/dl 或更高的选定非贫血患者进行亚组分析，比较两组之间血液学特征的变化。
分析了 IV 铁组的 30 例患者和对照组的 34 例患者。虽然术后并发症或死亡率无差异，但 IV 铁组术后两周血红蛋白和铁水平恢复明显更快。IV 铁组在整个术后期间铁水平明显更高。在非贫血患者的亚组分析中，尽管两组的基线血红蛋白水平相似，但 IV 铁组的血红蛋白水平恢复更快，整个术后期间维持更高。此外，IV 铁组的重症监护病房住院时间明显短于对照组。
术前静脉补铁可能有效促进 PD 后恢复期患者血液学特征的恢复，无论术前是否存在贫血，从而预防术后缺铁性贫血。
