title: Prognostic value of jaundice in patients with gallbladder cancer by the AFC-GBC-2009 study group.
abstract: BACKGROUND
  Jaundice is frequent in patients with gallbladder cancer (GBC) and indicates advanced disease and, according to some teams, precludes routine operative exploration. The present study was designed to re-assess the prognostic value of jaundice in patients with GBC.
  
  
  METHODS
  Patients with GBC operated from 1998 to 2008 were included in a retrospective multicenter study (AFC). The main outcome measured was the prognostic value of jaundice in patients with GBC focusing on morbidity, mortality and survival.
  
  
  RESULTS
  A total of 110 of 429 patients with GBC presented with jaundice, with a median age of 66 years (range: 31-88). The resectability rate was 45% (n=50) and the postoperative mortality and morbidity rates were 16% and 62%, respectively; 71% had R0 resection and 46% had lymph node involvement. Overall 1- and 3-year survivals of the 110 jaundiced patients were 41% and 15%, respectively. For the 50 resected patients, 1- and 3-year survivals were 48% and 19%, respectively (real 5-year survivors n=4) which were significantly higher than that of the 60 non-resected patients (31%, 0%, p=0.001). Among the resected jaundiced patients, T-stage, N and M status were found to have a significant impact on survival. R0 resection did not increase the overall survival in all resected patients, but R0 increased median survival in the subgroup of N0 patients (20 months versus 6 months, p=0.01).
  
  
  CONCLUSIONS
  This series confirms that jaundice is a poor prognostic factor. However, the presence of jaundice does not preclude resection, especially in highly selected patients (N0).
authors.affiliation: Department of Digestive Surgery, Amiens North Hospital, University of Picardy Medical Centre, Place Victor Pauchet, Amiens Cedex 01, France. regimbeau.jean-marc@chu-amiens.fr
authors.forename: J M
authors.initials: JM
authors.lastname: Regimbeau
authors.forename: D
authors.initials: D
authors.lastname: Fuks
authors.forename: P
authors.initials: P
authors.lastname: Bachellier
authors.forename: Y P
authors.initials: YP
authors.lastname: Le Treut
authors.forename: F R
authors.initials: FR
authors.lastname: Pruvot
authors.forename: F
authors.initials: F
authors.lastname: Navarro
authors.forename: L
authors.initials: L
authors.lastname: Chiche
authors.forename: O
authors.initials: O
authors.lastname: Farges
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000379:methods; D003135:Common Bile Duct / Q000601:surgery; D000075202:Contraindications; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007565:Jaundice / Q000209:etiology*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D012107:Research Design; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery