Malignant jaundice

Fifty-five consecutive patients presenting to a Surgical Unit for management of malignant obstructive jaundice are reported in this paper. An increasing incidence of bile-duct carcinoma has been noted since the end of 1983. The hospital mortality for all cases was 15%, a figure which did not differ significantly from the 11% mortality associated with the surgical management of benign obstructive jaundice. The median survival of patients with malignant obstructive jaundice was 6 months and the 2 year survival 10%. The only long-term survivors were those in whom pancreaticoduodenectomy was employed. Until radical improvements in treatment are achieved, effective palliation must remain the goal for the surgeon. This means that there is a need for rapid diagnosis, rapid decision making and early intervention to restore bile flow to the intestine. The best palliative procedure has yet to be defined and the status of stent insertion, of surgical bypass procedures and of palliative resection of some tumours remain unclear. Similarly, the place of adjuvant chemotherapy and radiotherapy have not been clearly established. There is a real need for a trial of various methods of treatment which employs an evaluation that takes into account both duration and quality of life.