Risk Factors for Ferritin Depletion in Post-gastrectomy Gastric Cancer Patients with Normal Baseline Ferritin Level

Abstract Purpose: Decreased iron absorption is one of the most important post-gastrectomy complications. We identified risk factors for ferritin depletion in post-gastrectomy gastric cancer patients with normal baseline ferritin levels.Material and Methods: Among 716 patients who underwent curative gastrectomy for gastric cancer during April 2009–August 2016, 445 were enrolled in the study. They were followed up for ≥3 years without recurrence and without baseline ferritin depletion (FD) (≥15 µg/L). Based on postoperative FD, the patients were divided into the ferritin non-depletion (FnD) (n=199) and FD (n=246) groups. Risk factor analysis for FD was performed using clinicopathologic and surgical factors, baseline ferritin levels, and pre-menopausal patient (PMP).Results: PMP (FD vs. FnD=27 [13.6%] vs. 13 [5.3%], P=0.004), non-smoking history (FD vs. FnD=48 [24.1%] vs. 84 [34.1%], P=0.028), duodenal bypassing reconstruction (FD vs FnD=160 [80.4%] vs. 163 [66.3%], P=0.001) and lower baseline ferritin with cut-off 55.7 µg/L were significant risk factors for FD. Multivariate analysis revealed that PMP, type of reconstruction method, and baseline ferritin level were independent risk factors. FD in the postoperative period differed significantly according to risk categories (low-risk group: 0-1 risk factors, high-risk group: 2-3 risk factors). Regarding long-term nutritional aspects, no significant difference existed between the groups with respect to weight changes, but hemoglobin levels were significantly lower in the FD group.Conclusion: Postoperative FD is a common post-gastrectomy complication in gastric cancer patients. PMP, food passage through the duodenum, and baseline ferritin level can be used to predict postoperative FD.