Jaundice Predicts Advanced Disease and Early Mortality in
Patients With Gallbladder Cancer
William G. Hawkins, MD, Ronald P. DeMatteo, MD, William R. Jarnagin, MD,
Leah Ben-Porat, MS, Leslie H. Blumgart, MD, and Yuman Fong, MD
Background: In patients with gallbladder cancer, jaundice suggests tumor involvement of the
porta hepatis. This study reports on the prevalence, etiology, and clinical significance of jaundice in
patients with gallbladder cancer.
Methods: Patients who presented with gallbladder cancer from 1995 to 2002 were entered into
a prospective database. Disease-specific survival and clinicopathologic correlates were analyzed.
Results: Eighty-two (34%) of 240 patients with gallbladder cancer presented with jaundice.
Jaundiced patients (96%) were more likely (P .001) to have advanced-stage disease than
nonjaundiced patients (60%). Only six (7%) jaundiced patients were resected with curative intent,
and only four (5%) had negative surgical margins. This was significantly different from the
nonjaundiced group, in which 62 patients (39%) had negative margins (P .001). The median
disease-specific survival in patients presenting with jaundice was 6 months and was significantly
lower compared with 16 months in patients without jaundice (P .0001). In the group presenting
with jaundice, there were no disease-free survivors at 2 years, compared with 21% in the group
without jaundice.
Conclusions: Jaundice is common (34%) in patients who present with gallbladder cancer and is
an indicator of advanced malignancy. These data do not support routine operative exploration of
patients with jaundice secondary to gallbladder cancer.
Key Words: Gallbladder—Cancer—Jaundice—Operative exploration.
Gallbladder cancer is an aggressive malignancy that
has a propensity to disseminate early. Historically, the
5-year survival of gallbladder cancer is 5%.
1
Until
recently, cure was achieved only when an early tumor
was found incidentally after cholecystectomy for pre-
sumed benign disease. Beginning in 1955 with George
Pack and associates’
2
description of right hepatectomy
and portal lymph node dissection in three patients with
gallbladder cancer, a trend toward more radical resection
has evolved. Nevertheless, gallbladder cancer has re-
mained a formidable problem. In the absence of effective
adjuvant therapy, the only curative treatment remains a
complete resection. In several series, 5-year survival
among completely resected patients with T2 tumors was
as high as 60% to 80%.
3–5
Unfortunately, the survival
benefit of wide surgical resection is available to only a
small population of patients with localized disease. In
several recent reviews, survival for the population of
patients with gallbladder cancer remains low. Cuber-
tafond et al.
6
reported on the French Surgical Association
Survey of 724 carcinomas of the gallbladder and de-
scribed a median survival of 3 months, a 1-year survival
of 14%, and a 5-year survival of 5%. A review of
gallbladder cancer from Australia reported a 12% 5-year
survival rate.
7
Notably, all survivors in this study had
stage I or II disease.
The major obstacle to cure in patients with gallbladder
cancer is that most present with advanced and therefore
unresectable disease. Experience has shown that gall-
bladder cancer is a rapidly growing tumor that dissemi-
nates early to multiple sites, including the regional lymph
nodes, distant hepatic parenchyma, and peritoneal sur-
Received March 6, 2003; accepted November 4, 2003.
From the Memorial Sloan-Kettering Cancer Center, New York, New
York.
Address correspondence and reprint requests to: Yuman Fong, MD,
Department of Surgery, Memorial Sloan-Kettering Cancer Center,
1275 York Avenue, New York, NY 10021; Fax: 212-639-4031;
E-mail: fongy@mskcc.org.
Published by Lippincott Williams & Wilkins © 2004 The Society of Surgical
Oncology, Inc.
Annals of Surgical Oncology, 11(3):310–315
DOI: 10.1245/ASO.2004.03.011
310