Malignant obstructive jaundice: Factors predictive of non Resectability at kenyatta National Hospital

Abstract

Malignant obstructive jaundice is a rising cause of mortality and morbidity in surgical patients worldwide. Most patients at time of presentation have advanced disease. Surgery remains the only curative mode of treatment for malignant obstructive jaundice, although there are other palliative measures that can be undertaken in patients with non-resectable disease. Since non curative resection increases morbidity, it is imperative that surgical resectability be known pre-operatively. Several factors have been proposed worldwide to determine resectability and non resectability, with contradictory data. The objective of this study was to determine the value of some of these factors in predicting non resectability of malignant obstructive jaundice and whether they should influence the decision to undertake surgical resection or attempt surgical palliation at Kenyatta National Hospital (KNH) as well as the extent of preoperative staging undertaken at KNH for patients with malignant obstructive jaundice. The study was a prospective descriptive study at Kenyatta National Hospital. The study population included all consenting patients with malignant obstructive jaundice admitted to the general surgical units and private wing of KNH with Malignant Obstructive Jaundice (MOJ). Data was collected in a pre-determined data collection sheet and analysed in SPSS, version 17.4. This study concluded that currently there is no staging system evident in the management of patients with MOJ. Ca 19-9 level of 466 has a 92.3% sensitivity and 100% specificity in predicting non resectability of MOl. CT scan in our set up has 85.18% sensitivity and 100% specificity in predicting non resectability of MOJ lesions at KNH. 21% of patients with MOJ who underwent laparotomy had no surgical intervention offered at surgery, definitive or palliative. With such high rate of non palliative surgery, this study concludes that there is a role for the use of Ca 19-9 and CT scan in predicting non resectability of MOJ lesions and probably offering other modes of non surgical palliation to patients with MOJ. 9