Reconstruction method as an independent risk factor for the postoperative decrease in hemoglobin in stage I gastric cancer.

Abstract

BACKGROUND AND AIM:

No study has compared the incidence of postoperative anemia between two reconstruction methods, Billroth-I (B-I) and Roux-en-Y (R-Y) reconstructions, after distal gastrectomy for gastric cancer (GC). In this study, we wished to examine the postoperative decrease in hemoglobin (Hb) as an indicator of iron-deficiency anemia.

METHODS:

We investigated a total of 119 consecutive patients who underwent distal gastrectomy with B-I or R-Y reconstruction for Stage I GC between 2006 and 2012. We retrospectively assessed the clinical data, including Hb results, of the first 2 years after surgery.

RESULTS:

Compared with B-I reconstruction, R-Y reconstruction was performed more frequently in older patients (P = 0.017), and it was associated with a longer surgical duration (P < 0.001), a larger amount of blood loss (P = 0.031), a higher incidence of stasis (P = 0.044), and a greater decrease in Hb for the first 2 years after surgery. Univariate and multivariate analyses identified that R-Y reconstruction was the only risk factor (P = 0.0487; odds ratio = 2.755; 95% confidence interval = 1.01-7.91) for a decrease in Hb, independent of age, tumor location, postoperative complications, and other factors. In addition, an age ≥ 75 was identified as an independent risk factor for a decrease in Hb, particularly for patients underwent R-Y reconstruction (P = 0.033; odds ratio = 6.99; 95% confidence interval = 1.15-68.3) according to the multivariate analysis.

CONCLUSIONS:

Billroth-I reconstruction might be preferable for the purpose of preventing a decrease in Hb in stage I GC patients, particularly in older patients.

• Authors: Taisuke Imamura, Shuhei Komatsu, Daisuke Ichikawa, Toshiyuki Kosuga, Kazuma Okamoto, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji
• Journal: Journal of gastroenterology and hepatology (J Gastroenterol Hepatol) Vol. 31 Issue 5 Pg. 959-64 (May 2016) ISSN: 1440-1746 [Electronic] Australia
• PMID: 26574141 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2015 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Chemical References

• Biomarkers
• Hemoglobins

Topics

• Age Factors
• Aged
• Anastomosis, Roux-en-Y (adverse effects)
• Anemia, Iron-Deficiency (blood, diagnosis, etiology)
• Biomarkers (blood)
• Blood Loss, Surgical
• Chi-Square Distribution
• Down-Regulation
• Female
• Gastrectomy
• Gastroenterostomy (adverse effects)
• Hemoglobins (metabolism)
• Humans
• Japan
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasm Staging
• Odds Ratio
• Operative Time
• Patient Selection
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Stomach Neoplasms (pathology, surgery)
• Time Factors
• Treatment Outcome