title: Implantation metastasis along the percutaneous transhepatic biliary drainage sinus tract.
abstract: We describe herein the case of a 75-year-old man with metastatic tumor seeding at the percutaneous transhepatic biliary drainage tract that occurred following a pylorus-preserving pancreatoduodenectomy for carcinoma of the distal common bile duct. On postoperative day 30, the catheter was removed and ethanol was injected into the percutaneous transhepatic biliary drainage sinus tract to prevent cancer implantation. One year and 3 months after the initial operation, abdominal computed tomography showed dilation of the left lateral segmental bile ducts and a 2-cm mass. The location of this mass corresponded to the puncture point from the previously performed percutaneous transhepatic biliary drainage. Implantation of the bile duct carcinoma at the percutaneous transhepatic biliary drainage sinus tract was diagnosed, and the recurrent tumor was successfully resected by performing a left hepatic lobectomy. Currently, 1 year after the second operation, the patient is in good health without any signs of recurrence. This case report demonstrates the importance of resecting the percutaneous transhepatic biliary drainage sinus tract during the initial surgery. If left in place, careful follow-up and awareness of this mode of tumor recurrence may lead to a timely resection, with preservation of a good quality of life and long-term survival.
authors.affiliation: Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan. yshimizu@aichi-cc.jp
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Kenzo
authors.initials: K
authors.lastname: Yasui
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kato
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Yamamura
authors.forename: Takashi
authors.initials: T
authors.lastname: Hirai
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
authors.forename: Yukihide
authors.initials: Y
authors.lastname: Kanemitsu
authors.forename: Seiji
authors.initials: S
authors.lastname: Ito
authors.forename: Naoshi
authors.initials: N
authors.lastname: Shibata
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamao
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ohhashi
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D001652:Bile Ducts / Q000473:pathology; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D004108:Dilatation, Pathologic; D004322:Drainage; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000601:surgery; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery; D008297:Male; D009366:Neoplasm Seeding; D016577:Pancreaticoduodenectomy