Jaundice: an important, poorly recognized risk factor for diminished survival in patients with adenocarcinoma of the head of the pancreas

Abstract

Preoperative jaundice is a negative risk factor in adenocarcinoma of the pancreas. Additional studies are required to determine the exact mechanism for this effect.

Severe Jaundice Increases Early Severe Morbidity and Decreases Long-Term Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

“…So, we could not analyze influence of jaundice duration, and a possible benefit of preoperative biliary drainage on early morbidity and late survival. However, is noteworthy that biliary drainage did not compromise long-term survival in the present study as in others (17) or seems even able to improve longterm survival (16).…”

“…However, a recent randomized controlled trial demonstrated that endoscopic biliary stenting should not be used routinely before PD when serum bilirubin level is below 250 µmoles/L because overall morbidity is significantly increased in patients who receive biliary stent while surgery-related complications are not decreased in the stent arm (12). Previous studies have also identified that jaundice negatively influenced long term survival after pancreatic resection for PDAC (13)(14)(15)(16)(17). However, in some studies jaundice per se was deleterious globally (13) or only in a subset of patients (16) whereas in others only severe jaundice according to variable definitions was associated with a decreased survival (14,15,17).…”

“…Previous studies have also identified that jaundice negatively influenced long term survival after pancreatic resection for PDAC (13)(14)(15)(16)(17). However, in some studies jaundice per se was deleterious globally (13) or only in a subset of patients (16) whereas in others only severe jaundice according to variable definitions was associated with a decreased survival (14,15,17). It is noteworthy that no study focused on patients with serum bilirubin level exceeding 250 µmoles/l.…”

Patients with Advanced Pancreatic Cancer and Hyperbilirubinaemia: Review and German Expert Opinion on Treatment with nab-Paclitaxel plus Gemcitabine

“…Biliary obstruction and the resulting hyperbilirubinaemia usually complicate the management of patients by increasing the risk of cholangitis and causing frequent hospitalisations [11]; hyperbilirubinaemia has been associated with shorter overall survival in patients with pancreatic cancer [12,13]. Biliary decompression in patients with obstructive hyperbilirubinaemia is commonly performed using endoscopic stent placement [10], which not only reduces morbidity [14] but also facilitates treatment with chemotherapy by allowing total bilirubin levels to drop to ≤ 1.5-2 times the upper limit of normal (≤ 1.5-2 × ULN).…”

Jaundice in resected pancreatic cancer patients

“…This difference was not statistically significant, but the findings of Strasberg et al 1 have been validated by other groups. 3 Following the approach used by Strasberg et al, 1 we found tumour size, alkaline phosphatase level, tumour-nodemetastasis (TNM) stage, grading and margin status to be significant prognostic factors in univariate analyses. When all factors were entered in a multivariate model, grading and margin status remained significant.…”