title: Reappraisal of percutaneous transhepatic biliary drainage tract recurrence after resection of perihilar bile duct cancer.
abstract: BACKGROUND
  The high incidence of percutaneous transhepatic biliary drainage (PTBD) tract recurrence after resection of perihilar bile duct cancer (BDC) at a reference single center has suggested the need for endoscopic biliary drainage (EBD) to prevent PTBD-related tumor recurrence. To determine the general applicability of these findings, we validated the risk of PTBD tract recurrence in patients with resected BDC in our high-volume center.
  
  
  METHODS
  The medical records of 306 patients with perihilar BDC who underwent hepatobiliary resection with curative intent over 10 years were reviewed retrospectively.
  
  
  RESULTS
  Of the 306 patients, 293 (95.8%) underwent biliary decompression, 171 (56.1%) by preoperative PTBD, 62 (20.3%) by EBD alone, and 60 (19.7%) by both. Of the 231 patients who underwent PTBD, 160 (69.3%), 62 (26.8%), and 9 (3.9%) had one, two, or three catheters, respectively (mean of 1.3 catheters per patient for a median 23 days). No patient experienced synchronous PTBD tract metastasis, whereas 4 (1.7%) experienced PTBD tract recurrence a median 13.5 months after surgery, with 3 of these patients having an intraabdominal recurrence soon afterward. Only one patient had a solitary tract recurrence without intraabdominal metastasis. These patients survived for a median 25 months, which is comparable to survival outcomes after noncurative resection. No risk factor was significantly associated with PTBD tract recurrence.
  
  
  CONCLUSIONS
  We think that the risk of PTBD tract recurrence after resection of perihilar BDC is not negligible but is much lower than previously reported. There is no definitive reason to avoid PTBD when it is indicated.
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Korea. shwang@amc.seoul.kr
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Lee
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Chul-Soo
authors.initials: CS
authors.lastname: Ahn
authors.forename: Kyu-Bo
authors.initials: KB
authors.lastname: Sung
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.forename: Myeong-Hwan
authors.initials: MH
authors.lastname: Kim
authors.forename: Sung-Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Deok-Bog
authors.initials: DB
authors.lastname: Moon
authors.forename: Dong-Hwang
authors.initials: DH
authors.lastname: Jung
authors.forename: Gil-Chun
authors.initials: GC
authors.lastname: Park
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000473:pathology* / Q000601:surgery; D004322:Drainage / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate