Should jaundice preclude resection in patients with gallbladder cancer? Results from a nation-wide cohort study

Elise A.J. de Savornin Lohman; Hendrien Kuipers; Mike van Dooren; Rob H.A. Verhoeven; Joris I. Erdmann; Bas Groot Koerkamp; Andries E. Braat; Jeroen Hagendoorn; Freek Daams; Ronald van Dam; Thomas M. van Gulik; Marieke T. de Boer; Philip R. de Reuver

doi:https://doi.org/10.1016/j.hpb.2020.03.015

Should jaundice preclude resection in patients with gallbladder cancer? Results from a nation-wide cohort study

Elise A.J. de Savornin Lohman, Hendrien Kuipers, Mike van Dooren, Rob H.A. Verhoeven, Joris I. Erdmann, Bas Groot Koerkamp, Andries E. Braat, Jeroen Hagendoorn, Freek Daams, Ronald van Dam, Thomas M. van Gulik, Marieke T. de Boer, Philip R. de Reuver

Research output: Contribution to journal › Article › Academic › peer-review

6 Citations (Scopus)

Abstract

Background: It is controversial whether patients with gallbladder cancer (GBC) presenting with jaundice benefit from resection. This study re-evaluates the impact of jaundice on resectability and survival. Methods: Data was collected on surgically explored GBC patients in all Dutch academic hospitals from 2000 to 2018. Survival and prognostic factors were assessed. Results: In total 202 patients underwent exploration and 148 were resected; 124 non-jaundiced patients (104 resected) and 75 jaundiced patients (44 resected). Jaundiced patients had significantly (P < 0.05) more pT3/T4 tumors, extended (≥3 segments) liver- and organ resections, major post-operative complications and margin-positive resection. 90-day mortality was higher in jaundiced patients (14% vs. 0%, P < 0.001). Median overall survival (OS) was 7.7 months in jaundiced patients (2-year survival 17%) vs. 26.1 months in non-jaundiced patients (2-year survival 39%, P < 0.001). In multivariate analysis, jaundice (HR1.89) was a poor prognostic factor for OS in surgically explored but not in resected patients. Six jaundiced patients did not develop a recurrence; none had liver- or common bile duct (CBD) invasion on imaging. Conclusion: Jaundice is associated with poor survival. However, jaundice is not an independent adverse prognostic factor in resected patients. Surgery should be considered in patients with limited disease and no CBD invasion on imaging.

Original language	English
Pages (from-to)	1686-1694
Number of pages	9
Journal	HPB
Volume	22
Issue number	12
Early online date	2020
DOIs	https://doi.org/10.1016/j.hpb.2020.03.015
Publication status	Published - Dec 2020

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de Savornin Lohman, E. A. J., Kuipers, H., van Dooren, M., Verhoeven, R. H. A., Erdmann, J. I., Groot Koerkamp, B., Braat, A. E., Hagendoorn, J., Daams, F., van Dam, R., van Gulik, T. M., de Boer, M. T., & de Reuver, P. R. (2020). Should jaundice preclude resection in patients with gallbladder cancer? Results from a nation-wide cohort study. HPB, 22(12), 1686-1694. https://doi.org/10.1016/j.hpb.2020.03.015

@article{9fd94b2bc0734e81abb94384439bf80e,

title = "Should jaundice preclude resection in patients with gallbladder cancer? Results from a nation-wide cohort study",

abstract = "Background: It is controversial whether patients with gallbladder cancer (GBC) presenting with jaundice benefit from resection. This study re-evaluates the impact of jaundice on resectability and survival. Methods: Data was collected on surgically explored GBC patients in all Dutch academic hospitals from 2000 to 2018. Survival and prognostic factors were assessed. Results: In total 202 patients underwent exploration and 148 were resected; 124 non-jaundiced patients (104 resected) and 75 jaundiced patients (44 resected). Jaundiced patients had significantly (P < 0.05) more pT3/T4 tumors, extended (≥3 segments) liver- and organ resections, major post-operative complications and margin-positive resection. 90-day mortality was higher in jaundiced patients (14% vs. 0%, P < 0.001). Median overall survival (OS) was 7.7 months in jaundiced patients (2-year survival 17%) vs. 26.1 months in non-jaundiced patients (2-year survival 39%, P < 0.001). In multivariate analysis, jaundice (HR1.89) was a poor prognostic factor for OS in surgically explored but not in resected patients. Six jaundiced patients did not develop a recurrence; none had liver- or common bile duct (CBD) invasion on imaging. Conclusion: Jaundice is associated with poor survival. However, jaundice is not an independent adverse prognostic factor in resected patients. Surgery should be considered in patients with limited disease and no CBD invasion on imaging.",

author = "{de Savornin Lohman}, {Elise A.J.} and Hendrien Kuipers and {van Dooren}, Mike and Verhoeven, {Rob H.A.} and Erdmann, {Joris I.} and {Groot Koerkamp}, Bas and Braat, {Andries E.} and Jeroen Hagendoorn and Freek Daams and {van Dam}, Ronald and {van Gulik}, {Thomas M.} and {de Boer}, {Marieke T.} and {de Reuver}, {Philip R.}",

year = "2020",

month = dec,

doi = "https://doi.org/10.1016/j.hpb.2020.03.015",

language = "English",

volume = "22",

pages = "1686--1694",

journal = "HPB",

issn = "1365-182X",

publisher = "John Wiley and Sons Inc.",

number = "12",

}

de Savornin Lohman, EAJ, Kuipers, H, van Dooren, M, Verhoeven, RHA , Erdmann, JI, Groot Koerkamp, B, Braat, AE, Hagendoorn, J, Daams, F, van Dam, R, van Gulik, TM, de Boer, MT & de Reuver, PR 2020, 'Should jaundice preclude resection in patients with gallbladder cancer? Results from a nation-wide cohort study', HPB, vol. 22, no. 12, pp. 1686-1694. https://doi.org/10.1016/j.hpb.2020.03.015

TY - JOUR

T1 - Should jaundice preclude resection in patients with gallbladder cancer? Results from a nation-wide cohort study

AU - de Savornin Lohman, Elise A.J.

AU - Kuipers, Hendrien

AU - van Dooren, Mike

AU - Verhoeven, Rob H.A.

AU - Erdmann, Joris I.

AU - Groot Koerkamp, Bas

AU - Braat, Andries E.

AU - Hagendoorn, Jeroen

AU - Daams, Freek

AU - van Dam, Ronald

AU - van Gulik, Thomas M.

AU - de Boer, Marieke T.

AU - de Reuver, Philip R.

PY - 2020/12

Y1 - 2020/12

N2 - Background: It is controversial whether patients with gallbladder cancer (GBC) presenting with jaundice benefit from resection. This study re-evaluates the impact of jaundice on resectability and survival. Methods: Data was collected on surgically explored GBC patients in all Dutch academic hospitals from 2000 to 2018. Survival and prognostic factors were assessed. Results: In total 202 patients underwent exploration and 148 were resected; 124 non-jaundiced patients (104 resected) and 75 jaundiced patients (44 resected). Jaundiced patients had significantly (P < 0.05) more pT3/T4 tumors, extended (≥3 segments) liver- and organ resections, major post-operative complications and margin-positive resection. 90-day mortality was higher in jaundiced patients (14% vs. 0%, P < 0.001). Median overall survival (OS) was 7.7 months in jaundiced patients (2-year survival 17%) vs. 26.1 months in non-jaundiced patients (2-year survival 39%, P < 0.001). In multivariate analysis, jaundice (HR1.89) was a poor prognostic factor for OS in surgically explored but not in resected patients. Six jaundiced patients did not develop a recurrence; none had liver- or common bile duct (CBD) invasion on imaging. Conclusion: Jaundice is associated with poor survival. However, jaundice is not an independent adverse prognostic factor in resected patients. Surgery should be considered in patients with limited disease and no CBD invasion on imaging.

AB - Background: It is controversial whether patients with gallbladder cancer (GBC) presenting with jaundice benefit from resection. This study re-evaluates the impact of jaundice on resectability and survival. Methods: Data was collected on surgically explored GBC patients in all Dutch academic hospitals from 2000 to 2018. Survival and prognostic factors were assessed. Results: In total 202 patients underwent exploration and 148 were resected; 124 non-jaundiced patients (104 resected) and 75 jaundiced patients (44 resected). Jaundiced patients had significantly (P < 0.05) more pT3/T4 tumors, extended (≥3 segments) liver- and organ resections, major post-operative complications and margin-positive resection. 90-day mortality was higher in jaundiced patients (14% vs. 0%, P < 0.001). Median overall survival (OS) was 7.7 months in jaundiced patients (2-year survival 17%) vs. 26.1 months in non-jaundiced patients (2-year survival 39%, P < 0.001). In multivariate analysis, jaundice (HR1.89) was a poor prognostic factor for OS in surgically explored but not in resected patients. Six jaundiced patients did not develop a recurrence; none had liver- or common bile duct (CBD) invasion on imaging. Conclusion: Jaundice is associated with poor survival. However, jaundice is not an independent adverse prognostic factor in resected patients. Surgery should be considered in patients with limited disease and no CBD invasion on imaging.

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U2 - https://doi.org/10.1016/j.hpb.2020.03.015

DO - https://doi.org/10.1016/j.hpb.2020.03.015

M3 - Article

C2 - 32340859

SN - 1365-182X

VL - 22

SP - 1686

EP - 1694

JO - HPB

JF - HPB

IS - 12

ER -

Should jaundice preclude resection in patients with gallbladder cancer? Results from a nation-wide cohort study

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