Esophageal Cancer Among Gastrointestinal Malignancies in the ICU: A Retrospective Analysis of the MIMIC-III Database

Background: Esophageal cancer (EC) is an aggressive malignancy that frequently presents at an advanced stage and may require intensive care because of postoperative monitoring or acute complications. Data describing how EC is represented among intensive care unit (ICU) admissions with gastrointestinal (GI) malignancies remains limited.

Methods: A retrospective analysis was performed using the Medical Information Mart for Intensive Care III (MIMIC-III) database. Adult ICU admissions from 2001 to 2012 with GI malignancies identified by ICD-9 codes 150–157 were included. Demographic variables, cancer site, and categorized length of stay were analyzed. Descriptive statistics were generated, and chi-square testing was used to examine associations between GI cancer site and sex, age group, ethnicity, and length-of-stay category.

Results: A total of 2,155 adult ICU admissions with GI cancer were included. Overall, 1,491 patients (68.8%) were male and 664 (30.7%) were female, with a median age of 67 years (IQR 58.0–77.45). Caucasian patients represented 73.7% of the cohort. EC accounted for 303 admissions (14.1%), making it the fourth most frequent GI cancer diagnosis after liver, pancreas, and colon cancer. Among patients with EC, 228 (75.2%) were male and 75 (24.8%) were female; the median age was 64 years (IQR 57.30–72.18), and 76.6% were Caucasian. The most common age group for EC was 60–69 years (36.6%), and the most frequent length-of-stay category was 7–13 days (42.2%). Cancer-site distribution differed significantly by sex, age group, ethnicity, and length-of-stay category (all p<0.001), although analysis involving ethnicity, age, and length of stay should be interpreted cautiously because several cells had expected counts below 5.

Conclusions: In this single-center ICU cohort, EC represented a substantial proportion of GI cancer
admissions and showed a marked male predominance with clustering in older adults. These findings
are hypothesis-generating and should be validated in multicenter datasets before being interpreted as
broader ICU admission patterns.

Keywords: Esophageal cancer, gastrointestinal malignancies, intensive care unit, MIMIC-III, critical care oncology