Keywords:
hepatocellular carcinoma, sub-Saharan Africa, South Africa, outcomes, jaundice, biliary drainage
Abstract
Background: Jaundice is a marker of advanced disease and poor outcomes in hepatocellular carcinoma (HCC). The aim of this study was to describe and analyse the management and outcomes of jaundiced HCC patients at a large academic referral centre in sub-Saharan Africa (SSA).
Methods: Treatment-naïve adult HCC patients who presented with jaundice between 1990 and 2023 were analysed.
Results: During the inclusion period, 676 HCC patients were treated at Groote Schuur Hospital. The mean age of the 126 (18.6%) who were jaundiced was 48.8 (± 13.2) years. Eighty-nine (70.6%) were male. Ninety-four (74.6%) patients with jaundice secondary to diffuse tumour infiltration had best supportive care (BSC) only. Thirty-two had obstructive jaundice (OJ); four were excluded because of missing hospital records. In 28 of these patients, 16 underwent biliary drainage (BD) and 12 received BSC only. The mean overall survival (OS) of the 126 patients was 100.5 (± 242.3) days. The patients with diffuse tumour infiltration had an OS of 105.9 (± 273.3) days. The patients with OJ survived 86.5 (± 135.0) days. There was no significant difference in OS between the three patient groups (p = 0.941). In the OJ group, patients who underwent BD survived longer than the BSC group (117.9 ± 166.4 vs. 29.2 ± 34.7 days, p = 0.015).
Conclusions: In this cohort of SSA patients, jaundice was a marker of advanced HCC with limited treatment options and poor OS. However, in carefully selected patients with OJ, BD is beneficial and improves survival.
Author Biographies
PB Keshaw, University of Cape Town
Surgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa
MM Bernon, University of Cape Town
Surgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa
M Emmamally, University of Cape Town
Surgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa
R Khan, University of Cape Town
Surgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa
UK Kotze, University of Cape Town
Surgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa
R Segobin, University of Cape Town
Division of Radiology, Department of Radiation Medicine, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa
D Creamer, University of Cape Town
Division of Radiology, Department of Radiation Medicine, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa
JEJ Krige, University of Cape Town
Surgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa
EG Jonas, University of Cape Town
Surgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa
S Sobnach, University of Cape Town
Surgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa
