Prognosis of Malignant Obstructive Jaundice Following Surgery for Gastric Carcinoma.

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.