title: Jaundice as a prognostic factor in patients undergoing radical treatment for carcinomas of the ampulla of Vater.
abstract: BACKGROUND
  Carcinomas of the ampulla of Vater (CAV) is a relatively rare malignant gastrointestinal tumor, and its postoperative prognostic factors have been well studied. However, as its first symptom, the impact of jaundice on the prognosis of CAV is not so clear. This study aims to explore the role of jaundice as a prognostic factor in patients undergoing radical treatment for CAV.
  
  
  METHODS
  The clinical data of 195 patients with CAV who were treated in the Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, from January 1989 to January 2013 were retrospectively analyzed. Among them, 170 patients with pathologically confirmed CAV entered the statistical analysis. Jaundice was defined as a total bilirubin serum concentration of ≥ 3 mg/dl. Result Of these 170 patients, 99 (58.20%) had jaundice at presentation. Jaundice showed significant correlations with tumor differentiation (P = 0.002), lymph node metastasis (P = 0.016), pancreatic invasion (P = 0.000), elevated preoperative CA199 (P = 0.000), depth of invasion (P = 0.000), and tumor stage (P = 0.000). There were more patients with pancreatic invasion in the jaundice group than in the non-jaundice group. Also, lymph node metastasis was more common in the jaundice group (n = 26) than in the non-jaundice group (n = 8). The non-jaundice group had significant better overall 5-year disease-free survival (72.6%) than the jaundice group (41.2%, P = 0.013). Jaundice was not significantly correlated with the postoperative bleeding (P = 0.050).
  
  
  CONCLUSIONS
  Jaundice in patients with CAV often predicts more advanced stages and poorer prognoses. Pancreatic invasion and lymph node metastasis are more common in CAV patients with jaundice. Jaundice is not a risk factor for postoperative bleeding and preoperative biliary drainage cannot reduce the incidence of postoperative complications.
authors.affiliation: Department of Abdominal Surgery, Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Jianguo
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of General Surgery, Aerospace Central Hospital, Beijing 100049, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Abdominal Surgery, Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Abdominal Surgery, Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Shan
authors.affiliation: Department of Abdominal Surgery, Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China. Email: dbzhao2003@sina.com.
authors.forename: Dongbing
authors.initials: D
authors.lastname: Zhao
authors.affiliation: Department of Abdominal Surgery, Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Jianqiang
authors.initials: J
authors.lastname: Cai
mesh_terms: D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007565:Jaundice / Q000503:physiopathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy