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Updated: Aug 9, 2026
Application of Hemostatic Devices in Laparoscopic Hepatectomy
Published on: April 19, 2022
Modified transferrin saturation is associated with postoperative complications in patients undergoing curative
Chishou Mitsuura1, Satoshi Ida1, Hiroki Tsubakihara1
1Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
Background:
Surgical complications after gastrectomy significantly impact recovery and long-term prognosis. While iron status influences outcomes, the conventional 20% transferrin saturation (TSAT) threshold ignores sex-specific physiological differences. We developed a modified TSAT (mTSAT) based on sex and anemia status and evaluated its value in predicting complications.
Methods:
We retrospectively analyzed 243 patients who underwent curative gastrectomy. Optimal TSAT cut-off values for predicting complications classified as Clavien-Dindo grade II or higher were determined using receiver operating characteristic curves stratified by sex and anemia status. Predictive performance was compared between mTSAT and the conventional 20% threshold using the corrected Akaike Information Criterion.
Results:
The optimal mTSAT cut-offs were 22.2% for men and 14.2% for women. The mTSAT model demonstrated an improved fit compared with the conventional threshold. The low mTSAT group (mTSAT below the sex-specific cut-off) comprised 78 patients and exhibited a significantly higher incidence of complications than the normal mTSAT group, particularly anastomotic leakage and delayed gastric emptying/ileus. Moreover, postoperative hospital stay was significantly longer in this group. In the primary multivariable analysis, low mTSAT was significantly associated with postoperative complications, whereas the conventional 20% threshold was not. After additional adjustment for clinical stage and surgical approach, the association was attenuated and no longer reached statistical significance.
Conclusions:
Preoperative low mTSAT was associated with an increased risk of postoperative complications. Rather than a standalone predictor, mTSAT functions as a valuable composite clinical indicator reflecting stage-related systemic vulnerability, surgical invasiveness, and underlying malnutrition or iron deficiency.
