Impact of bowel ischemia on mortality in gastrointestinal malignancies: A nationwide analysis.

person Natchaya Polpichai Department of Medicine, Weiss Memorial Hospital, Chicago, IL info_outline Natchaya Polpichai, Sakditad Saowapa, Phuuwadith Wattanachayakul, Aunchalee Jaroenlapnopparat, Monzer Abdalla, Chawin Lopimpisuth, Ekaphop Sirachainan

Authors person Natchaya Polpichai Department of Medicine, Weiss Memorial Hospital, Chicago, IL info_outline Natchaya Polpichai, Sakditad Saowapa, Phuuwadith Wattanachayakul, Aunchalee Jaroenlapnopparat, Monzer Abdalla, Chawin Lopimpisuth, Ekaphop Sirachainan Organizations Department of Medicine, Weiss Memorial Hospital, Chicago, IL, Texas Tech University Health Sciences Center, Lubbock, TX, Department of Medicine, Albert Einstein Healthcare Network, Philadelphia, PA, Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Boston, MA, Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, Division of Medical Oncology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Abstract Disclosures Research Funding No funding sources reported Background: Bowel ischemia, characterized by reduced blood supply to the gastrointestinal (GI) tract, critically influences the pathogenesis and outcomes of GI malignancies through complex interactions involving vascular compromise, tumor biology, and systemic consequences. Despite this, the link between bowel ischemia and increased mortality in GI cancers remains unknown. This study aims to evaluate the impact of bowel ischemia on in-hospital mortality in GI cancer patients in the United States. Methods: This retrospective analysis utilized the 2016-2020 National Inpatient Survey (NIS) database. Adults aged 18 and above with esophageal, gastric, colon, cholangiocarcinoma, hepatocellular carcinoma, and pancreatic cancers were identified using the International Classification of Disease-10 (ICD-10) code. The cohort was stratified into patients with and without bowel ischemia. Hospital mortality was analyzed using STATA 18, adjusting for age, gender, race, insurance, Charlson’s index, baseline hospital characteristics, and comorbidities. Multivariate logistic regression analysis was performed, with all P values ≤ 0.05 considered statistically significant. Results: Among 2,133,465 adults with GI malignancies, 3,240 were hospitalized with bowel ischemia. Patients with bowel ischemia were older (mean age 68.10 vs. 67.07 years, P = 0.033), predominantly from the Southern region (33.49%, P = 0.019), and urban and teaching hospitals (76.83%; P = 0.006). Bowel ischemia was most associated with Pancreatic cancer (37.35%), Colon cancer (35.49%), and Hepatocellular carcinoma (11.57%). Within the cohort of patients with bowel ischemia, gastric cancer patients had the highest mortality rates of 45.83%. After adjusting for potential confounders, patients with gastric, esophageal, colon, and pancreatic cancers had significantly higher odds of in-hospital mortality of 11.90, 6.45, 4.14, 4.08, and 2.71, respectively. Conclusions: This study reveals an association between outcomes in hospitalized GI cancer patients and bowel ischemia, leading to increased mortality despite adjusting for potential confounders. Bowel ischemia significantly heightens the mortality risk in GI cancers through impaired nutrient and oxygen delivery, enhanced tumor aggressiveness, systemic inflammation, immune suppression, and compromised treatment efficacy. Understanding the intricate interplay between vascular compromise and cancer biology is crucial to improving patient care and outcomes in the face of these challenging malignancies.