Jaundice at Presentation Heralds Advanced Disease and Poor Prognosis in Patients with Ampullary Carcinoma

Abstract

Jaundice is a common manifestation of ampullary carcinoma. The aim of this study was to evaluate the correlation between jaundice at initial presentation and the degree of tumor spread and to determine the prognostic significance of jaundice in patients with ampullary carcinoma. Fifty-nine patients who had undergone curative resection for ampullary carcinoma were analyzed retrospectively. Jaundice was defined as a total bilirubin serum concentration of > or = 3 mg/dl. The median follow-up time was 106 months. Jaundice was noted at the time of initial presentation in 43 (73%) patients. Jaundice at presentation correlated with lymph node metastasis (p < 0.0001), lymphatic vessel invasion (p < 0.0001), invasion into the pancreas (p = 0.0007), and vascular invasion (p = 0.0487). Pancreatic invasion was absent in patients without jaundice. Superior mesenteric nodal involvement was more frequent in patients with jaundice (15/43) than in those without (0/16) (p = 0.0062). The survival of patients with jaundice (median survival 48 months; cumulative 10-year survival rate 39%) was worse than for patients without jaundice (median survival time not available; cumulative 10-year survival rate 86%) (p = 0.0014). In conclusion, jaundice at presentation predicts advanced-stage ampullary carcinoma and a poor prognosis. Pancreatic invasion and superior mesenteric nodal involvement were not observed in nonjaundiced patients.

Surgical Outcomes and Prognostic Factors for Ampulla of Vater Cancer

“…The resectability rate (R0 resection) was 85.9%. In the review of literature the 5-and 10-year survival rates have been reported to be 38.2%~67.7% and 31.6%~53%, respectively (3,4,12,(14)(15)(16)(17)(18)(19)(20)(21). The rate of potentially curative resection has been reported to be high up to 98% (3,14,16).…”

“…However, preoperative biliary drainage was performed more frequently in jaundiced patients. Some authors have reported that jaundice at presentation was associated with poorer survival (21,22). Jaundice at presentation may reflect a more advanced disease and may indicate a poorer prognosis for the patient (21).…”

“…The rate of potentially curative resection has been reported to be high up to 98% (3,14,16). The prognostic factors for ampulla of Vater cancers following surgery have been reported to be jaundice (21,22), depth of tumor infiltration (3,4,22), pancreatic invasion (3,12,15,16,21), lymph node metastasis (3,4,14,15,22), perineural invasion (3,16,18,21), tumor differentiation (14,16), and residual tumor status (16). The routine use and duration of preoperative biliary drainage in jaundiced patients was controversial.…”

Preoperative cholangitis independently increases in-hospital mortality after combined major hepatic and bile duct resection for hilar cholangiocarcinoma

“…Jaundice, defined as a serum total bilirubin concentration of ≥3 mg/dL [33], was noted at the time of presentation in 63 patients, 62 of whom underwent a preoperative biliary drainage. Nine other patients with no jaundice also had a biliary drainage to decompress the dilated bile ducts in the future remnant liver (n=6) or to treat preoperative cholangitis (n=3).…”

Carcinoma of the papilla of Vater following treatment ofpancreaticobiliary maljunction

“…Compared with other periampullary carcinomas, including those of the duodenum, bile duct, and pancreas, survival and resectability rates of carcinoma of the papilla of Vater are relatively high [9,10] . In addition to the fact that the rate of resection is one of the predictive factors for survival [9] , early detection is of great importance to provide benefit for patients with carcinoma of the papilla of Vater [11] . One of the most common manifestations at presentation in patients with carcinoma of the papilla of Vater is jaundice, as in the other periampullary carcinomas.…”