Abstract

Surgeons and oncologists consider the development of late jaundice following curative resection in advanced gastric cancer patients to be an untreatable condition of cancer recurrence. Usually they opt for a conservative management approach rather than to attempt aggressive diagnosis and treatment. To evaluate the justify of this approach, authors retrospectively reviewed 629 cases of curative resections for advanced gastric cancer that had been performed at the Korea University Hospital during a six years time period between Jan. 1986 to Jan. 1992. Of the 629 patients, 51 patients had either bilirubin levels greater than 2 mg% or had shown signs of clinical jaundice. The patients were classified in the following method: type 1a: single liver metastasis, 1b; multiple liver metastases, 2; hepatoduodenal ligament LN metastases, 3; GB or CBD stones, 4; chemotherapy toxicity, 5; hepatitis. We observed 3 cases(6%) of type 1a, 10 cases(19%) of type lb, 14 cases(27%) of type 2, 5 cases(10%) of type 1a+2, 7 cases(14 %) of type 1b+2, 6 cases(12%) of type 3, 4 cases(8%) of type 4, 2 cases(4%) of type 5. The onset of jaundice development differed between recurrent and nonrecurrent jaundice. In nonrecurrent cases, the late jaundice developed shortly after the operative procedure, whereas jaundice usually appeared l yerar after the operation in recurrent cases. There was no significant difference in the primary site of advanced gastric cancer between recurrent and nonrecurrent jaundice. Although late jaundice usually developed in patients with TNM stage II and III cancers, there was no significant difference between the recurrent and nonrecurrent cases. Management of late jaundice consisted of aggressive procedures such as choledochotomy, cholecystectomy, PTCD(Percutaneous transhepatic cholangiography with drainage) and conservative approaches for nonrecurrent cases, and hepatectomy, PTCD, RT (Radiotheraphy) and choledochotomy was done in recurrent cases. These procedures resulted in good outcomes with symptomatic improvement and a better quality of life. The duration of survival in patient who received treatment for the jaundice was on average 8 months in the recurrent cases and 33 months in the nonrecurrent cases, whereas a surviva1 of only 2.4 months was observed in patients who received no treatment for the late jaundice. The results of this study strongly suggested that aggressive approaches in the diagnosis and treatment for late jaundice following curative resection of advanced gastric cancer leads to a longer duration of survival and a better quality of life. We concluded that aggressive treatment for patients developing late jaundice should be performed for the better outcome of patients.

• Keywords: Stomach cancer, Curative resection, Late jaundice