Jaundice Predicts Advanced Disease and Early Mortality in Patients With Gallbladder Cancer
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Background: In patients with gallbladder cancer, jaundice suggests tumor involvement of the porta hepatis. This study reports on the prevalence, etiology, and clinical significance of jaundice in patients with gallbladder cancer.
Methods: Patients who presented with gallbladder cancer from 1995 to 2002 were entered into a prospective database. Disease-specific survival and clinicopathologic correlates were analyzed.
Results: Eighty-two (34%) of 240 patients with gallbladder cancer presented with jaundice. Jaundiced patients (96%) were more likely (P < .001) to have advanced-stage disease than nonjaundiced patients (60%). Only six (7%) jaundiced patients were resected with curative intent, and only four (5%) had negative surgical margins. This was significantly different from the nonjaundiced group, in which 62 patients (39%) had negative margins (P < .001). The median disease-specific survival in patients presenting with jaundice was 6 months and was significantly lower compared with 16 months in patients without jaundice (P < .0001). In the group presenting with jaundice, there were no disease-free survivors at 2 years, compared with 21% in the group without jaundice.
Conclusions: Jaundice is common (34%) in patients who present with gallbladder cancer and is an indicator of advanced malignancy. These data do not support routine operative exploration of patients with jaundice secondary to gallbladder cancer.
Key WordsGallbladder Cancer Jaundice Operative exploration
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- 1.Piehler JM, Crichlow RW. Primary carcinoma of gallbladder. Surg Gynecol Obstet 1978;147:929–42.Google Scholar
- 2.Pack GT, Miller TR, Brasfield RD. Total right hepatic resection lobectomy for cancer of the gallbladder. Ann Surg 1955;142:6–16.Google Scholar
- 3.Fong Y, Jarnagin W, Blumgart LH. Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention. Ann Surg 2000;232:557–66.Google Scholar
- 4.Wagholikar GD, Behari A, Krishnani N, et al. Early gallbladder cancer. J Am Coll Surg 2002;194:137–41.Google Scholar
- 5.Ouchi K, Owada Y, Matsuno S, Sato T. Prognostic factors in the surgical treatment of gallbladder carcinoma. Surgery 1987;101:731–7.Google Scholar
- 6.Cubertafond P, Gainant A, Cucchiaro G. Surgical treatment of 724 carcinomas of the gallbladder. Results of the French Surgical Association Survey. Ann Surg 1994;219:275–80.Google Scholar
- 7.Wilkinson DS. Carcinoma of the gallbladder—an experience and review of the literature. Aust N Z J Surg 1995;65:724–7.Google Scholar
- 8.Ogura Y, Mizumoto R, Isaji S, Kusuda T, Matsuda S, Tabata M. Radical operations for carcinoma of the gallbladder—present status in Japan. World J Surg 1991;15:337–43.Google Scholar
- 9.Donohue JH, Nagorney DM, Grant CS, Tsushima K, Ilstrup DM, Adson MA. Carcinoma of the gallbladder—does radical resection improve outcome? Arch Surg 1990;125:237–41.Google Scholar
- 10.Kondo S, Nimura Y, Hayakawa N, Kamiya J, Nagino M, Uesaka K. Extensive surgery for carcinoma of the gallbladder. Br J Surg 2002;89:179–84.Google Scholar
- 11.Blalock A. A statistical study of 888 cases of biliary tract disease. Johns Hopkins Hosp Bull 1924;35:391–409.Google Scholar
- 12.De Aretxabala XA, Roa IS, Burgos LA, Araya JC, Villaseca MA, Silva JA. Curative resection in potentially resectable tumours of the gallbladder. Eur J Surg 1997;163:419–26.Google Scholar
- 13.Matsumoto Y, Fujii H, Aoyama H, Yamamoto M, Sugahara K, Suda K. Surgical treatment of primary carcinoma of the gallbladder based on the histologic analysis of 48 surgical specimens. Am J Surg 1992;163:239–45.Google Scholar
- 14.Shirai Y, Yoshida K, Tsukada K, Muto T, Watanabe H. Radical surgery for gallbladder carcinoma—long-term results. Ann Surg 1992;216:565–8.Google Scholar
- 15.Shirai Y, Yoshida K, Tsukada K, Muto T. Inapparent carcinoma of the gallbladder—an appraisal of a radical 2nd operation after simple cholecystectomy. Ann Surg 1992;215:326–31.Google Scholar
- 16.Onoyama H, Yamamoto M, Tseng A, Ajiki T, Saitoh Y. Extended cholecystectomy for carcinoma of the gallbladder. World J Surg 1995;19:758–63.Google Scholar
- 17.Oertli D, Herzog U, Tondelli P. Primary carcinoma of the gallbladder—operative experience during a 16 year period. Eur J Surg 1993;159:415–20.Google Scholar
- 18.Bartlett DL, Fong YM, Fortner JG, Brennan MF, Blumgart LH. Long-term results after resection for gallbladder cancer—implications for staging and management. Ann Surg 1996;224:639–46.Google Scholar
- 19.Nakamura S, Sakaguchi S, Suzuki S, Muro H. Aggressive surgery for carcinoma of the gallbladder. Surgery 1989;106:467–73.Google Scholar
- 20.Weber SM, DeMatteo RP, Fong YM, Blumgart LH, Jarnagin WR. Staging laparoscopy in patients with extrahepatic biliary carcinoma—analysis of 100 patients. Ann Surg 2002;235:392–9.Google Scholar
- 21.Schwartz LH, Gruen DR, Winston CB, Jamagin WR, Fong Y, Panicek DM. MR imaging and MR cholangiopancreatography of gallbladder cancer. Radiology 1998;209P:485.Google Scholar
- 23.Thorbjarnarson B. Carcinoma of biliary tree. 1. Carcinoma of gallbladder. N Y State J Med 1975;75:550–2.Google Scholar