NDLI: Jaundice: an important, poorly recognized risk factor for diminished survival in patients with adenocarcinoma of the head of the pancreas.

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Jaundice: an important, poorly recognized risk factor for diminished survival in patients with adenocarcinoma of the head of the pancreas.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Strasberg, Steven M. Gao, Feng Sanford, Dominic Linehan, David C. Hawkins, William G. Fields, Ryan Carpenter, Danielle H. Brunt, Elizabeth M. Phillips, Carolyn
Description	Country affiliation: United States Author Affiliation: Strasberg SM ( Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Washington University in St Louis, St Louis, MO, USA)
Abstract	OBJECTIVES: Jaundice impairs cellular immunity, an important defence against the dissemination of cancer. Jaundice is a common mode of presentation in pancreatic head adenocarcinoma. The purpose of this study was to determine whether there is an association between preoperative jaundice and survival in patients who have undergone resection of such tumours. METHODS: Thirty possible survival risk factors were evaluated in a database of over 400 resected patients. Univariate analysis was used to determine odds ratio for death. All factors for which a P-value of <0.30 was obtained were entered into a multivariate analysis using the Cox model with backward selection. RESULTS: Preoperative jaundice, age, positive node status, poor differentiation and lymphatic invasion were significant indicators of poor outcome in multivariate analysis. Absence of jaundice was a highly favourable prognostic factor. Interaction emerged between jaundice and nodal status. The benefit conferred by the absence of jaundice was restricted to patients in whom negative node status was present. Five-year overall survival in this group was 66%. Jaundiced patients who underwent preoperative stenting had a survival advantage. CONCLUSIONS: Preoperative jaundice is a negative risk factor in adenocarcinoma of the pancreas. Additional studies are required to determine the exact mechanism for this effect.
File Format	HTM / HTML
ISSN	1365182X
e-ISSN	14772574
DOI	10.1111/hpb.12094
Journal	HPB
Issue Number	2
Volume Number	16
Language	English
Publisher	Elsevier
Publisher Date	2014-02-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Gastroenterology Adenocarcinoma Mortality Surgery Jaundice, Obstructive Pancreatic Neoplasms Complications Diagnosis Diagnosis, Differential Etiology Kaplan-meier Estimate Pancreatectomy Pancreaticoduodenectomy Prognosis Risk Factors Stents
Content Type	Text
Resource Type	Article
Subject	Hepatology Gastroenterology

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