Failure to improve survival by improved diagnostic techniques in patients with malignant jaundice

Abstract

In a consecutive series of 118 patients with malignant obstructive jaundice at North Tees General Hospital only 70 patients were adjudged fit to undergo surgery. Tumour resection was possible in only four patients. Palliative bypass was performed in 45 patients while 21 patients had no procedure other than an exploratory laparotomy. In contrast to the accuracy of investigation the results of surgery have been poor with considerable mortality (42.8 per cent) and lack of long-term survivors. The results emphasize the role of non-surgical methods for relieving jaundice of malignant aetiology, especially in frail elderly patients and those who have metastases at the time of presentation.

Fate of patients with obstructive jaundice

“…Thus, unfortunately, the prognosis of patients presenting with jaundice caused by hepatobiliary cancer obstructing the biliary ducts (or due to liver metastases) does not seem to have improved during the last 3 decades. The most common cause of malignant obstructive jaundice in the current study was pancreatic cancer, which is in agreement what was reported in earlier studies 3, 11–15. The poor prognosis of patients with pancreatic cancer is well known, but operative mortality is very low nowadays, and some series have reported 5‐year survival rates in the range of 10%–30% 16–20.…”

“…Studies published more than 20 years ago are available on the etiology and prognosis of these patients, reflecting the diagnostic techniques and hospital practice at that time 6–9. Furthermore, more recently published studies report the etiological spectrum of patients with obstructive jaundice in Africa and India 10–12. In our study population, 154 of 241 patients (64%) had a malignancy, which is remarkably similar to the 61% and 65% of cases of obstructive jaundice due to malignancy reported in studies published more than 25 years ago from Denmark and Spain, respectively 6–7, 14…”

“…The patients whose OJ was caused by a malignancy had a mortality rate of approximately 95% during the study's rather short follow‐up. Previous studies, mostly from the 1980s, found similarly dismal outcomes,12–13 suggesting that the prognosis of these patients has not improved during the last 3 decades. Among patients hospitalized for malignant obstructive jaundice in Denmark in the 1970s and the beginning of the 1980s, 1‐year survival was reported to be 11% 14.…”

“…However, the clinical features of malignant versus benign causes of jaundice have not been a focus of interest during the last decades, and it is not clear from the literature what proportion of patients with choledocholithiasis and jaundice present with silent jaundice. Studies on the prognosis of patients with jaundice were published more than 20 years ago, prior to major advances in imaging modalities and endoscopic treatment 6–14. Thus, we aimed to study the clinical features, etiology, and prognosis of patients presenting with obstructive jaundice in the current era of improved imaging and noninvasive treatment.…”

Accuracy of Diagnosis of Pancreatic Cancer Decreases with Increasing Age

“…Our survival data showed a 5‐year survival of 27.6% in Stage I in the nonpathologically confirmed group compared to 4% in the pathologically confirmed group. Other studies have shown that in pathologically confirmed cases, whether treated by resection, bypass procedures, or irradiation, the mean survival has usually been less than 1 year with a range from 2.5–13 months 9,10,17‐21 . Our survival data suggest that in a substantial number of cases the clinical diagnosis of carcinoma of the pancreas is incorrect.…”