Background : Little attention has been devoted to exploring the occurrence and implications of postoperative anemia. This study aims to investigate the incidence of anemia in patients undergoing PD for pancreatic cancer at immediate postoperative, and 3-4 months postoperative stages and additionally, the study seeks to assess the impact of postoperative anemia on outcomes after PD and how patients prognosis could become differ by correcting postoperative anemia with intravenous Ferric carboxymaltose.

Methods : A total of 1069 patients who underwent pancreaticoduodenectomy (PrPD, PPPD) for pancreatic cancer between January 1,2014 and December 31, 2018 at Asan Medical Center in Korea was analyzed. Among of 1069 patients, 858 were suitable for analysis in the study. Patients were classified as anemic according to WHO(World Health Organization) parameter, setting the hemoglobin level cut off below 12g/dL for females and below 13g/dL for males. The presence or absence of complications classified by Clavien-Dindo class was established as the primary outcome.

Results : Among total 858, 608 patients experienced postoperative anemia and 141 individuals received ferrinject. In 608 patients, postoperative anemia was associated with increased complication rates (p = 0.018) and perioperative allogenic blood transfusions (p < 0.001). Multivariate analysis showed that anemia was associated with a 7% (95%CI 0.02–0.57 p = 0.047) increase in Complication rate, and was an independent factor associated with perioperative blood transfusion (OR 2.762, 95%CI 1.72–4.49, p < 0.001).

Conclusions : Postoperative anemia is an independent risk factor for heightened complication severity and the need for blood transfusion in patients undergoing significant pancreatic resection.