title: Outcomes in patients with obstructive jaundice from metastatic colorectal cancer and implications for management.
abstract: BACKGROUND
  Patients with metastatic colorectal cancer can develop jaundice from intrahepatic or extrahepatic causes. Currently, there is little data on the underlying causes and overall survival after onset of jaundice. The purpose of this study was to characterize the causes of jaundice and determine outcomes.
  
  
  METHODS
  Six hundred twenty-nine patients treated for metastatic colorectal cancer between 2004 and 2010 were retrospectively reviewed. Those developing jaundice were grouped as having intrahepatic or extrahepatic obstruction. Demographics, clinicopathologic, and outcome data were analyzed.
  
  
  RESULTS
  Sixty-two patients with metastatic colorectal cancer developed jaundice. Intrahepatic biliary obstruction was most common, occurring in younger patients. Time from metastatic diagnosis to presentation of jaundice was similar between groups, as was the mean number of prior lines of chemotherapy. Biliary decompression was successful 41.7 % of the time and was attempted more commonly for extrahepatic causes. Median overall survival after onset of jaundice was 1.5 months and it was similar between groups, but improved to 9.6 months in patients who were able to receive further chemotherapy.
  
  
  CONCLUSIONS
  Jaundice due to metastatic colorectal cancer is an ominous finding, representing aggressive tumor biology or exhaustion of therapies. Biliary decompression is often difficult and should only be pursued when additional treatment options are available.
authors.affiliation: Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 410 West 10th Ave, N924 Doan Hall, Columbus, OH, 43210, USA.
authors.forename: Shawnn D
authors.initials: SD
authors.lastname: Nichols
authors.forename: Scott
authors.initials: S
authors.lastname: Albert
authors.forename: Lawrence
authors.initials: L
authors.lastname: Shirley
authors.forename: Carl
authors.initials: C
authors.lastname: Schmidt
authors.forename: Sherif
authors.initials: S
authors.lastname: Abdel-Misih
authors.forename: Samer
authors.initials: S
authors.lastname: El-Dika
authors.forename: J Royce
authors.initials: JR
authors.lastname: Groce
authors.forename: Christina
authors.initials: C
authors.lastname: Wu
authors.forename: Richard M
authors.initials: RM
authors.lastname: Goldberg
authors.forename: Tanios
authors.initials: T
authors.lastname: Bekaii-Saab
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000150:complications / Q000473:pathology*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis / Q000556:secondary*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed