JAUNDICE IN PATIENTS WITH GALL BLADDER CANCER- A SURROGATE MARKER OF ADVANCED DISEASE

Background: Gall bladder cancer (GBC) is most common cancer of biliary tract. R0 resection is the most important predictor of survival. Patients with GBC and jaundice do worse than those without jaundice. Methods: Retrospective analysis of prospectively kept data of patients with GBC admitted to the department of Surgical Gastroenterology at a tertiary care hospital in northern India over10 years from 2011 to 2020. Data on patient demography, clinical profile, imaging characteristics, clinical course, staging, and operative procedures was extracted and analyzed to compare the experience of patients with GBC with jaundice and GBC without jaundice. Results: There were 401 patients with GBC; 75 with jaundice and 326 without jaundice. Patients with GBC and jaundice had a significantly higher incidence of pain abdomen, loss of appetite, loss of weight and presence of an abdominal lump, gastric outlet obstruction and hypoalbuminemia, a shorter duration of symptoms, more number of hospital admissions, a less frequent (4% vs 10.7%) incidental diagnosis of GBC and a higher incidence of GB neck tumors (80% vs 20%). In patients with GBC and jaundice detection of metastatic or locally advanced unresectable disease on imaging (31%), laparoscopy (11%) or laparotomy (31%) precluded resection in majority of patients. Only 2.6% patients with GBC and jaundice could undergo definitive surgery as compared to 71.2% of patients without jaundice. Conclusion: Patients with GBC and jaundice are very likely to have advanced, unresectable disease. Chances of complete resection are slim even after extensive preparation requiring more extensive, time-consuming, costly, multidisciplinary interventions.