J.Jpn. Surg. Soc.. 60(10): 1660-1682, 1959

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IRON METABOLISM OF PATIENTS WITH CANCER OF THE STOMACH AND GASTRODUODENAL ULCERS. REPORT Ⅲ. CHANGES IN SERUM IRON IN RELATION TO SURGICAL TREATMENTS; RESULTS OF ORAL IRON TOLERANCE TESTS FOLLOWING OPERATIONS.

The materials for observation consisted of a total of 84 cases of which 39 were patients with carcinoma of the stomach, 38 with gastroduodenal ulcers and 7 with other types of gastric disorders. All of these cases were selected from 570 patients who had been admitted to our department during the three year period (January 1954-December 1956) and treated as accurately diagnosed cases for the diseases of the stomach and duodenum. The influence of surgical treatment upon serum iron was studied experimentally and oral iron tolerance tests were applied on or about 14 days postoperatively in these patients. The results obtained may be summarized as follows :
1) The level of serum iron decreases remarkably after surgical treatment in patients with gastric carcinoma as compared with the preoperative value. However, with the lapse of time there is a tendency to rise again until it reaches its maximum on the 14th day. This rise in serum iron is most apparent, often reaching the normal level, in patients who had undergone radical treatment resulting in the total excision of the tumor. On the contrary, the serum iron level remains low on the 14th day in patients with unremovable tumors, in whom only gastrointestinal anastomosis or simple exploratory laparotomy had beed done. Frequently these patients show extremely low serum iron values. It is also noteworthy that the increase in serum seen postoperatively is closely related to the magnitude of operative stress and to the nature of clinical symptoms.
2) Likewise in patients with gastroduodenal ulcers the quantity of serum iron first decreases after gastrectomy. It tends to increase, however, reaching the normal level of serum iron on the 14th day postoperatively after reaching the level far below that of preoperative or normal value.
3) In patients with gastric carcinoma and those with gastroduodenal ulcers, the fluctuations in the serum iron level generally show similar tendencies, the variations often being those of quantities on any given postoperative day. However, the fluctuations in patients with cancer of the stomach tend to be far lower than in ulcer patients, when the values of serum iron are compared on any postoperative day.
4) The curves of iron absorption on or about the 14th postoperative day show a marked tendency to decrease rather than increase, and the quantity of iron absorption also is below that of normal individuals. Consequently, iron absorption is not as good as that of normal persons.
5) while the iron absorption curves on or about the 14th day after gastrectomy in patients with gastroduodenal ulcers frequently reveal an increased quantity of serum iron, the great majority never surpass that of normal persons. Consequently, the quantity of iron absorbed is smaller than that of normal individuals, showing an impaired iron absorption rate.
6) No significant differences are noted in the iron absorption curves on or about the 14th post-gastrectomy day between the operations following Billroth I and II techniques.
(Author's abstract)

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