Vitamin B12 deficiency after esophagectomy with gastric tube reconstruction for esophageal cancer.

The aim of this study is to determine the prevalence and incidence of vitamin B12 deficiency after esophagectomy for cancer. It is unknown if patients after esophagectomy with gastric tube reconstruction are at an increased risk for vitamin B-12 deficiency. A cross-sectional cohort (group A) and a prospective cohort (group B) of patients who underwent esophagectomy for cancer in two tertiary referral centers in the Netherlands were included. Serum levels of holo-transcobalamin (Holo-TC) and methyl malonic acid (MMA) were determined. Vitamin B-12 deficiency was defined as Holo-TC < 21 pmol/L and/or MMA > 0.45 mu mol/L. Vitamin B-12 status was assessed in group A at a single time point between one and three years postoperatively and before and every three months after resection in group B. Ninety-nine patients were analyzed in group A. The median time between surgery and analysis of vitamin B-12 deficiency was 19.3 months. In 11 of 99 (11%) patients, vitamin B-12 deficiency was detected. In group B, 5 of 88 (5.6%) patients had vitamin B-12 deficiency preoperatively, and another 9 (10.2%) patients developed vitamin B-12 deficiency after the operation at a median time of 6 months postoperatively. The estimated one-year incidence of vitamin B-12 deficiency was 18.2%. None of the patients with vitamin B-12 deficiency had a megaloblastic anemia. Vitamin B-12 deficiency can be anticipated in 18% of patients after esophagectomy with gastric tube reconstruction for cancer. During follow-up, Holo-TC and MMA levels should be measured to detect vitamin B-12 deficiency and commence treatment timely.