Jaundice predicts advanced disease and early mortality in patients with gallbladder cancer.
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.
Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
William G
WG
Hawkins
Ronald P
RP
DeMatteo
William R
WR
Jarnagin
Leah
L
Ben-Porat
Leslie H
LH
Blumgart
Yuman
Y
Fong
D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007565:Jaundice / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome