Prognosis of Malignant Obstructive Jaundice Following Surgery for Gastric Carcinoma

Song, Jae Hyun; Yoon, Ki Young; Lee, Sang Ho

Abstract

PURPOSE
Obstructive jaundice is a rare presentation, but is an ominous prognostic sign in patients undergoing surgery for a gastric carcinoma. Therefore, we investigated the prognosis of malignant obstructive jaundice following surgery for a gastric carcinoma. MATERIALS AND METHODS: Thirty-eight patients, with an extrahepatic biliary obstruction due to a metastatic gastric carcinoma, were retrospectively studied to determine their demographics, clinical features, laboratory finding, pathological characteristics and survival. RESULTS: Between January 1996 and April 2000, 2401 patients underwent operations for gastric cancer, of which 38 (1.6%) were found to have obstructive jaundice. The mean age was 55.9 +/- 10.7 years, and the sex ratio (male: female) was 3.2: 1. The median interval between the previous gastrectomy and the presentation of jaundice was 10.1 8.9 months. The levels of total bilirubin and direct bilirubin were 16.5 +/- 6.5 and 12.0 +/- 4.4, respectively. The most common site of the obstruction was the common bile duct (65%). An antrumal location, poorly differentiated stage IV gastric cancer was common associated with obstructive jaundice. A percutaneous transhepatic biliary drainage was a commonly used treatment modality. When the clinical and laboratory findings were presented to a Cox regression analysis, the P values of the time interval and albumin were 0.019 and 0.057, respectively. CONCLUSION: The time interval between a previous gastrectomy, the presentation of jaundice and albumin level were found to be independent risk factors for predicting the survival.