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01-12-2014 | Original Article

Outcomes in Patients with Obstructive Jaundice from Metastatic Colorectal Cancer and Implications for Management

Authors: Shawnn D. Nichols, Scott Albert, Lawrence Shirley, Carl Schmidt, Sherif Abdel-Misih, Samer El-Dika, J. Royce Groce, Christina Wu, Richard M. Goldberg, Tanios Bekaii-Saab, Mark Bloomston

Published in: Journal of Gastrointestinal Surgery | Issue 12/2014

Abstract

Introduction

Patients with metastatic colorectal cancer can develop jaundice from intrahepatic or extrahepatic causes. Currently, there is little data on the underlying causes and overall survival after onset of jaundice. The purpose of this study was to characterize the causes of jaundice and determine outcomes.

Methods

Six hundred twenty-nine patients treated for metastatic colorectal cancer between 2004 and 2010 were retrospectively reviewed. Those developing jaundice were grouped as having intrahepatic or extrahepatic obstruction. Demographics, clinicopathologic, and outcome data were analyzed.

Results

Sixty-two patients with metastatic colorectal cancer developed jaundice. Intrahepatic biliary obstruction was most common, occurring in younger patients. Time from metastatic diagnosis to presentation of jaundice was similar between groups, as was the mean number of prior lines of chemotherapy. Biliary decompression was successful 41.7 % of the time and was attempted more commonly for extrahepatic causes. Median overall survival after onset of jaundice was 1.5 months and it was similar between groups, but improved to 9.6 months in patients who were able to receive further chemotherapy.

Conclusions

Jaundice due to metastatic colorectal cancer is an ominous finding, representing aggressive tumor biology or exhaustion of therapies. Biliary decompression is often difficult and should only be pursued when additional treatment options are available.

Manfredi S, Lepage C, Hatem C, et al. Epidemiology and management of liver metastases from colorectal cancer. Ann Surg. 2006;244(2):254–259.PubMedCentralPubMedCrossRef

Leporrier J, Maurel J, Chiche L, et al. A population-based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer. Br J Surg 2006;93(4):465–474.PubMedCrossRef

Lam VW, Spiro C, Laurence JM, et al. A systematic review of clinical response and survival outcomes of downsizing systemic chemotherapy and rescue liver surgery in patients with initially unresectable colorectal liver metastases. Ann Surg Oncol 2012; 19(4):1292–1301.PubMedCrossRef

Abdalla EK, Bauer TW, Chun YS, et al. Locoregional surgical and interventional therapies for advanced colorectal cancer liver metastases: expert consensus statements. HPB(Oxford) 2013;15(2):119–130.

Warshaw AL and Welch JP. Extrahepatic biliary obstruction by metastatic colon carcinoma. Ann Surg 1978;188(5):593–597.PubMedCentralPubMedCrossRef

Douillard JY, Siena S, Cassidy J, et al. Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study. J Clin Oncol 2010;28(31):4697–4705.PubMedCrossRef

Tveit KM, Guren T, Glimelius B, et al. Phase III trial of cetuximab with continous or intermittent fluorouracil, leucovorin, and oxaliplatin (Nordic FLOX) versus FLOX alone in first-line treatment of metastatic colorectal cancer: the NORDIC-VII study. J Clin Oncol 2012;30(15):1755–1762.PubMedCrossRef

Van Laethem JL, De Broux S, Eisendrath P, et al. Clinical Impact of biliary drainage and jaundice resolution in patients with obstructive jaundice at the hilum. Am J Gastroenterol 2003;98(6):1271–1277.PubMedCrossRef

Lo CY and Lai EC. Palliation for extrahepatic biliary obstruction by metastatic colorectal carcinoma. Am J Gastroenterol 1994;89(10):1852–1855.PubMed

10.

Elias DM and Ouellet JF. Incidence, distribution, and significance of hilar node metastases in hepatic colorectal metastases. Surg Oncol Clin N Am 2003;12(1):221–229.PubMedCrossRef

11.

Bennett JJ, Schmidt CR, Klimstra DS, et al. Perihepatic lymph node micrometastases impact outcome after partial hepatectomy for colorectal metastases. Ann Surg Oncol 2008;15(4):1130–1136.PubMedCrossRef

12.

Rodgers MS, and McCall JL. Surgery for colorectal liver metastases with hepatic lymph node involvement: a systemic review. Br J Surg 2000;87(9):1142–1155.PubMedCrossRef

13.

Laurent C, Sa Cunha A, Rullier E, et al. Smith Impact of microscopic hepatic lymph node involvement on survival after resection of colorectal liver metastases. J Am Coll Surg 2004;198(6):884–891.PubMedCrossRef

14.

Beckurts KT, Holscher AH, Thorban S, et al. Significance of lymph node involvement at the hepatic hilum in the resection of colorectal liver metastases. Br J Surg 1997;(8):1081–1084.CrossRef

15.

Iwatsuki S, Dvorchik I, Madariaga JR, et al. Hepatic Resection for Metastatic Colorectal Adenocarcinoma: A Proposal of a Prognostic Scoring System. J Am Coll Surg 1999;189(3):291–299.PubMedCentralPubMedCrossRef

16.

Caprizo DR, Are C, Jarnagin W, Dematteo R, Fong Y, Gonen M, Blumgart L, D’Angelica M. Liver resection for metastatic colorectal cancer in patients with concurrent extrahepatic disease: results in 127 patients treated at a single center. Ann Surg Onc. 2009;16(8):2138–2146.CrossRef

17.

Nakamura S, Suzuki S, and Konno H. Resection of hepatic metastases of colorectal carcinoma: 20 years’ experience. J Hepatobiliary Pancreat Surg 1999;6(1):16–22.PubMedCrossRef

18.

Ercolani G, Grazi GL, Ravaioli M, et al. The role of lymphadenectomy for liver tumors. Ann Surg. 2004;239(2):202–209.PubMedCentralPubMedCrossRef

19.

Jamison RL Donohue JH Nagorney DM et al. Hepatic resection for metastatic colorectal cancer results in cure for some patients. Arch Surg. 1997;132(5):505–510.PubMedCrossRef

20.

Elias D, Ouellet JF, Bellon N, et al. Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases. Br J Surg 2003;90(5):567–574.PubMedCrossRef

Title: Outcomes in Patients with Obstructive Jaundice from Metastatic Colorectal Cancer and Implications for Management
Authors: Shawnn D. Nichols
Scott Albert
Lawrence Shirley
Carl Schmidt
Sherif Abdel-Misih
Samer El-Dika
J. Royce Groce
Christina Wu
Richard M. Goldberg
Tanios Bekaii-Saab
Mark Bloomston
Publication date: 01-12-2014
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 12/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-014-2670-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Outcomes in Patients with Obstructive Jaundice from Metastatic Colorectal Cancer and Implications for Management

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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