Malignant Obstructive Jaundice Following Gastrectomy for Gastric Carcinoma

ABSTRACT

PURPOSE: Although obstructive jaundice is a rare presentation, it is an omnious prognostic sign in patients with gastrectomy for gastric carcinoma. The major cause of bile duct obstruction has been identified as lymphadenopathy in the hepatoduodenal ligament that has metastasized from predominantly advanced gastric carcinomas. METHODS: Extrahepatic biliary obstruction caused by metastatic gastric carcinoma was retrospectively studied in order to determine demographics, pathological characteristics, time interval from previous gastrectomy, site of recurrence, and the prognosis of the disease. RESULTS: In this study, 983 patients with gastric adenocarcinoma underwent gastrectomy, and obstructive jaundice was revealed in 22 patients (2.2%). The mean age of the patients was 56 years, and the male to female sex ratio was 1.7 1. Antrally located, poorly differentiated, and advanced stage (above III) gastric carcinoma were commonly associated with obstructive jaundice. The most common site of the obstruction was the porta hepatis (54%). A percutaneous transhepatic biliary drainage (PTBD) procedure was accomplished in 19 patients and the jaundice was decreased, however the survival was not improved. The mean duration from jaundice to death was 2.8 months. CONCLUSION: These results show that the cause of bile duct obstruction in advanced gastric carcinoma was predominantly metastatic lymphadenopathy in the hepatoduodenal ligament. In order to improve the quality of life in obstructive jaundiced patients, further evaluation and continued follow-up and examination may be necessary.