Abstract
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.
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References
Piehler JM, Crichlow RW. Primary carcinoma of gallbladder. Surg Gynecol Obstet 1978;147:929–42.
Pack GT, Miller TR, Brasfield RD. Total right hepatic resection lobectomy for cancer of the gallbladder. Ann Surg 1955;142:6–16.
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.
Wagholikar GD, Behari A, Krishnani N, et al. Early gallbladder cancer. J Am Coll Surg 2002;194:137–41.
Ouchi K, Owada Y, Matsuno S, Sato T. Prognostic factors in the surgical treatment of gallbladder carcinoma. Surgery 1987;101:731–7.
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.
Wilkinson DS. Carcinoma of the gallbladder—an experience and review of the literature. Aust N Z J Surg 1995;65:724–7.
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.
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.
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.
Blalock A. A statistical study of 888 cases of biliary tract disease. Johns Hopkins Hosp Bull 1924;35:391–409.
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.
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.
Shirai Y, Yoshida K, Tsukada K, Muto T, Watanabe H. Radical surgery for gallbladder carcinoma—long-term results. Ann Surg 1992;216:565–8.
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.
Onoyama H, Yamamoto M, Tseng A, Ajiki T, Saitoh Y. Extended cholecystectomy for carcinoma of the gallbladder. World J Surg 1995;19:758–63.
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.
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.
Nakamura S, Sakaguchi S, Suzuki S, Muro H. Aggressive surgery for carcinoma of the gallbladder. Surgery 1989;106:467–73.
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.
Schwartz LH, Gruen DR, Winston CB, Jamagin WR, Fong Y, Panicek DM. MR imaging and MR cholangiopancreatography of gallbladder cancer. Radiology 1998;209P:485.
Schwartz LH, Black J, Fong Y, et al. Gallbladder carcinoma: findings at MR imaging with MR cholangiopancreatography. J Comput Assist Tomogr 2002;26:405–10.
Thorbjarnarson B. Carcinoma of biliary tree. 1. Carcinoma of gallbladder. N Y State J Med 1975;75:550–2.
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Hawkins, W.G., DeMatteo, R.P., Jarnagin, W.R. et al. Jaundice Predicts Advanced Disease and Early Mortality in Patients With Gallbladder Cancer. Ann Surg Oncol 11, 310–315 (2004). https://doi.org/10.1245/ASO.2004.03.011
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DOI: https://doi.org/10.1245/ASO.2004.03.011