493. IRON DEFICIENCY AFTER ONCOLOGICAL ESOPHAGECTOMY AND GASTRECTOMY

Abstract Removal of the entire stomach or parts of it may affect iron absorption and storage. These conditions mainly caused by altering the acid environment, bypassing the duodenal passage during reconstruction or by chronic inflammatory processes. In addition, patients with esophageal or gastric cancer often have an iron deficiency preoperatively due to malnutrition, gastrointestinal hemorrhage, or inflammatory processes. Sometimes these iron deficiencies lead to microcytic hypochromic deficiency anemia. Between January 2015 and December 2019, 103 (=66%) esophagectomy patients and 54 (=34%) (sub)total gastrectomy patients were included. Fe, transferrin and ferritin were collected prospectively to be used for retrospective descriptive analysis: preoperatively and three, six, twelve, 18 and 24 months after the operations. The exclusion criteria were: Age below 18, primary bone marrow disease, hereditary forms of anemia, postoperative tumor recurrence, R1/R2 situation. Iron supplementation was not used in the first postoperative year, and thereafter only in cases of a severe iron deficiency. The severity of iron deficiency was classified by ferritin, according to iron deficiency stages I—III. 18% of patients with oncological esophagectomy and 45% of patients with oncological (sub)total gastrectomy have an iron deficiency two years after the operations. This is manifested mainly by pathologically decreased ferritin levels. There is only a significant difference between the groups, with respect to ferritin (p = 0.021) and transferrin levels (p = 0.028), after 2 postoperative years. 75% of esophagectomy patients with iron deficiency were in stage I, 12.5% in stage II and 12.5% in stage III of iron deficiency. 56% of iron deficiency patients with (sub)total gastrectomy were in stage I, 22% in stage II and 22% in stage III. Patients with (sub)total gastrectomy are more likely to have iron deficiency than patients with esophagectomy during the 24-month postoperative follow-up period. Due to the duodenal bypassing in the (sub)total gastrectomy group a higher prevalence of iron deficiency could have been expected. Most patients have storage iron deficiency (= stage I). Only few patients with iron deficiency have the more severe and decompensated form of iron deficiency, iron deficiency anemia (= stage III).