Correlation of preoperative anemia subtypes with tumor characteristics, systemic inflammation and immediate postoperative outcomes in gastrointestinal cancer patients – a prospective observational study

Purpose: Patients with Gastrointestinal (GI) malignancies more frequently present with anemia. A large proportion of them exhibits a systemic inflammatory response causing anemia of chronic disease. Although tumor factors play an essential role in determining the prognosis, studies have also reported the role of host factors in the outcome. This study was done to determine the association between systemic inflammation, tumor characteristics, and immediate postoperative outcome among various anemia subgroups. Methods This was a single-center, prospective observational study of patients undergoing treatment for GI cancers. The modified Glasgow prognostic Score (mGPS) was calculated and patients were followed up until discharge regarding postoperative complications, length of the hospital, ICU stay, and mortality. The patient demographics, tumor characteristics, systemic inflammation, and postoperative complications were studied among different subtypes of anemia. Results A total of 209 patients were analysed, and a higher prevalence of normocytic anemia (52.63%) and systemic inflammatory response (62.21%) was observed among the study population. Systemic inflammation was significantly associated with a higher nodal stage (p = 0.02) and margin positivity (p = 0.006). Patients with higher mGPS had significantly higher requirements for blood transfusion (p = 0.003), superficial SSI (p = 0.03), and sepsis (p = 0.02), however, other postoperative complications were comparable among patients without an inflammatory response. Conclusion High prevalence of systemic inflammation and resultant normocytic anemia among GI cancers warrants thorough knowledge in this field among the treating surgeons. This study opens up a platform for further research to consider anti-inflammatory agents in its management to circumvent the morbidity of blood transfusions.