Outcomes in Patients with Obstructive Jaundice from Metastatic Colorectal Cancer and Implications for Management

Abstract

Introduction 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.

Can MELD score be a predictor of liver metastasis in colorectal cancer?

“…Similarly, hepatic dysfunction can develop in patients with metastatic liver disease, depending on the extent and localization of the lesions. For instance, hyperbilirubinemia caused by various factors such as metastatic portal lymph node enlargement and replacement of hepatic parenchyma by cancerous tissue is not a rare condition in these patients, and is associated with poor prognosis [19]. In addition, coagulation disorders can develop in cancer patients with or without liver metastasis.…”

Palliative Care in Colorectal Cancer

“…In cases of more advanced disease, patients may present with jaundice (due to liver metastasis or biliary tract obstruction) or malignant ascites. As the number of patients with malignant distal biliary obstruction who will undergo curative surgery is limited, endoscopy has a crucial role in palliation [22].…”

Clinical outcomes of biliary drainage of malignant biliary obstruction due to colorectal cancer metastases: A systematic review

“…Malignant biliary obstruction is an ominous complication of metastatic colorectal cancer (mCRC) and is associated with a poor prognosis. [1][2][3] It has been reported to occur in 10% of patients with known mCRC. [1] Malignant biliary obstruction can be caused by either intrahepatic metastases or extrahepatic lymph node or peritoneal metastases located at the liver hilum or along the extrahepatic bile duct.…”

“…[1][2][3] It has been reported to occur in 10% of patients with known mCRC. [1] Malignant biliary obstruction can be caused by either intrahepatic metastases or extrahepatic lymph node or peritoneal metastases located at the liver hilum or along the extrahepatic bile duct. It significantly impacts clinical outcomes and is often treated in palliative settings.…”

“…Median survival after the onset of jaundice is only around one month when treated with supportive care. [1][2][3] Improved palliative systemic therapy regimens, along with increased use of hepatic resections, showed improved overall survival in mCRC patients. Some agents however, in particular irinotecan, are contraindicated in patients with obstructive jaundice and hyperbilirubinemia.…”