title: The prognostic importance of jaundice in surgical resection with curative intent for gallbladder cancer.
abstract: BACKGROUND
  Preoperative jaundice is frequent in gallbladder cancer (GBC) and indicates advanced disease. Resection is rarely recommended to treat advanced GBC. An aggressive surgical approach for advanced GBC remains lacking because of the association of this disease with serious postoperative complications and poor prognosis. This study aims to re-assess the prognostic value of jaundice for the morbidity, mortality, and survival of GBC patients who underwent surgical resection with curative intent.
  
  
  METHODS
  GBC patients who underwent surgical resection with curative intent at a single institution between January 2003 and December 2012 were identified from a prospectively maintained database.
  
  
  RESULTS
  A total of 192 patients underwent surgical resection with curative intent, of whom 47 had preoperative jaundice and 145 had none. Compared with the non-jaundiced patients, the jaundiced patients had significantly longer operative time (p < 0.001) and more intra-operative bleeding (p = 0.001), frequent combined resections of adjacent organs (23.4% vs. 2.8%, p = 0.001), and postoperative complications (12.4% vs. 34%, p = 0.001). Multivariate analysis showed that preoperative jaundice was the only independent predictor of postoperative complications. The jaundiced patients had lower survival rates than the non-jaundiced patients (p < 0.001). However, lymph node metastasis and gallbladder neck tumors were the only significant risk factors of poor prognosis. Non-curative resection was the only independent predictor of poor prognosis among the jaundiced patients. The survival rates of the jaundiced patients with preoperative biliary drainage (PBD) were similar to those of the jaundiced patients without PBD (p = 0.968). No significant differences in the rate of postoperative intra-abdominal abscesses were found between the jaundiced patients with and without PBD (n = 4, 21.1% vs. n = 5, 17.9%, p = 0.787).
  
  
  CONCLUSIONS
  Preoperative jaundice indicates poor prognosis and high postoperative morbidity but is not a surgical contraindication. Gallbladder neck tumors significantly increase the surgical difficulty and reduce the opportunities for radical resection. Gallbladder neck tumors can independently predict poor outcome. PBD correlates with neither a low rate of postoperative intra-abdominal abscesses nor a high survival rate.
authors.forename: Xin-wei
authors.initials: XW
authors.lastname: Yang
authors.forename: Jian-mao
authors.initials: JM
authors.lastname: Yuan
authors.forename: Jun-yi
authors.initials: JY
authors.lastname: Chen
authors.forename: Jue
authors.initials: J
authors.lastname: Yang
authors.forename: Quan-gen
authors.initials: QG
authors.lastname: Gao
authors.forename: Xing-zhou
authors.initials: XZ
authors.lastname: Yan
authors.affiliation: Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai 200438, China. weicelia@163.com.
authors.forename: Bao-hua
authors.initials: BH
authors.lastname: Zhang
authors.forename: Shen
authors.initials: S
authors.lastname: Feng
authors.forename: Meng-chao
authors.initials: MC
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000556:secondary; D006801:Humans; D007565:Jaundice / Q000150:complications / Q000401:mortality* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate