The prognostic importance of jaundice in surgical resection with curative intent for gallbladder cancer

Abstract

BackgroundPreoperative 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.MethodsGBC 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.ResultsA 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).ConclusionsPreoperative 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.

Gallbladder Cancer Presenting with Jaundice: Uniformly Fatal or Still Potentially Curable?

“…More recently, in 2014, investigators from Shanghai, China reported a 5-year survival of 6% in 47 patients with GBC and jaundice undergoing surgical resection. 13 Taken together, the results of these 5 previous studies appear to be in agreement with our study, where the actuarial 5-year survival for jaundiced GBC patients undergoing resection was noted to be 9%.…”

“…Approximately a quarter to a third of patients with GBC present with obstructive jaundice, 3, 6, 13 and resectability rates among jaundiced patients has been reported to be anywhere between 7% and 49%. 14, 3, 15, 6 While surgical resection is the single potentially curative option in this setting, there is no firm consensus on the appropriateness of surgery for jaundiced patients with GBC.…”

“…16 Along the same lines, subsequent studies from other institutions around the world have reproduced these modestly improved survival outcomes after surgical resection of GBC in the setting of jaundice, including studies from Japan (reporting a median survival of 18 months), 15 France (11 months), 6 India (26 months), 14 and China (14 months). 13 …”

Long-Term Outcomes and Prognostic Factors in Advanced Gallbladder Cancer: Focus on the Advanced T Stage

“…Thus preoperative jaundice should be considered a relative contraindication to radical resection for GBC [33]. However, recent reports have demonstrated declared that although preoperative jaundice indicates poor prognosis and high postoperative morbidity, it does not preclude radical resection, especially in highly selected patients (N0) [34,35], and aggressive surgery might improve long-term survival in advanced GBC patients with obstructive jaundice [36]. In this study, patients with obstructive jaundice who underwent curative resection had overall survival that were similar to those in patients without obstructive jaundice, and jaundice at diagnosis showed no prognostic impact once R0 was achieved.…”

The role of microRNAs in gallbladder cancer

“…Despite advances in the treatment of GBC in recent years, the majority of patients eventually develop local recurrent or distant metastatic disease, which is associated with a poor prognosis and an overall 5-year survival rate of <10% (4)(5)(6)(7). Early diagnosis, which is crucial for long-term survival of GBC patients, unfortunately occurs only accidentally in patients undergoing cholecystectomy for gallstones or cholecystitis, while the majority of the patients present with advanced metastatic disease due to the absence of specific symptoms and efficient biomarkers (8)(9)(10)(11)(12). Additionally, coadjuvant therapy consisting of chemotherapy and̸or radiotherapy has not yet proved beneficial in terms of patient survival (13)(14)(15)(16).…”