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VITAMIN B12 STATUS FOLLOWING A RIGHT HEMICOLECTOMY IN CANCER: A FEASIBILITY STUDY
Anwen Williams*1, Joanne Carter3, Pallavi Basu1, Mark Williams2, Paul Edwards1
1Surgery, Nevill Hall Hospital , Abergavenny, United Kingdom; 2University of South Wales, Pontypridd, United Kingdom; 3Biochemistry, Nevill Hall Hospital, Abergavenny, United Kingdom
Introduction
Resection of terminal ileum in patients with Crohns disease results in vitamin B12 deficiency therefore these patients are routinely given B12 supplementation to prevent anaemia and neuropsychiatric disease. The affect of right hemicolectomy on B12 status in cancer patients has not previously been studied. Furthermore, B12 assay may not be sensitive enough to detect B12 deficiency at the tissue level and this may be more accurately reflected in assays of homocysteine (HCyst) and methylmalonic acid (MMA), which are co-metabolites of B12. We therefore studied the effect of right hemicolectomy on levels of B12, active B12, HCyst and MMA in patients with colon cancer.
Methods
Patients who had a right hemicolectomy for colon cancer and been in remission for over 2 years were identified. Participants were recruited and invited to attend a clinic to check both standard and active B12 status (Abbott ARCHITECT), plasma MMA, HCyst and folate concentrations. A control group of age matched healthy participants were also recruited. Exclusion criteria were patients already receiving vitamin B12 supplementation, pregnancy, anaemia, or those unable to give written consent. Ethical approval was obtained.
Results
Twenty-seven control patients were recruited, 22 male and 5 female, age 74+/-10 years (mean +/- standard deviation-SD). Twenty-eight surgical patients were recruited, 18 male, 10 female, age 74+/-8 years (mean+/-SD). HCyst were 15.8+/-7 mmol/L in the surgical group 13.2+/-6.2 mmol/L in the control group (p=0.037). There was no difference in MMA, folate and active B12 levels between the two groups (p > 0.05).
Conclusion
Right hemicolectomy for malignancy is associated with a significant increase in HCyst levels. This may indicate a reduction in tissue levels of vitamin B12 although serum B12 is normal. This requires further study.
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