title: Catheter tract recurrence after percutaneous biliary drainage for hilar cholangiocarcinoma.
abstract: BACKGROUND
  Despite its wide use, catheter tract recurrence after percutaneous biliary drainage (PBD) is rarely reported. However, one recent large-scale study reported a catheter tract recurrence rate as high as 5.2 % in patients with perihilar or distal bile duct cancer. We report on our 20 years of experience with catheter tract seeding after PBD for hilar cholangiocarcinoma.
  
  
  METHODS
  The medical records of 441 patients who underwent operation for hilar cholangiocarcinoma between 1991 and 2011 were retrospectively analyzed.
  
  
  RESULTS
  Of the 441 patients with hilar cholangiocarcinoma, PBD was performed in 315 patients, and 232 others underwent resection of hilar cholangiocarcinoma with PBD. Catheter tract recurrence developed in 6 patients (2.6 %). The median drainage duration was 30 days, and 1 patient had multiple PBDs. The median time to catheter recurrence after surgery was 10.9 months. Three patients underwent curative resection of the abdominal wall followed by chemotherapy, 1 patient underwent chemotherapy only, and 2 patients received conservative treatment. Five patients in whom the catheter tract recurrence was their first recurrence died of systemic recurrence at median 3.9 months after detection of catheter tract seeding. T1 or 2 disease (66.7 vs. 31.3 %; p = 0.086) tended to have catheter tract seeding with marginal significance. The overall survival rate was lower in patients with catheter tract seeding than in those without (median 17.5 vs. 23.0 months; p = 0.089).
  
  
  CONCLUSIONS
  The PBD catheter tract recurrence rate for hilar cholangiocarcinoma was 2.6 %. However, patients with catheter tract recurrence had a poor prognosis despite complete surgical metastasectomy.
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea. meejookang@gmail.com
authors.forename: Mee Joo
authors.initials: MJ
authors.lastname: Kang
authors.forename: Yun-Suk
authors.initials: YS
authors.lastname: Choi
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Jang
authors.forename: In Woong
authors.initials: IW
authors.lastname: Han
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D001653:Bile Ducts, Intrahepatic / Q000473:pathology* / Q000601:surgery; D002404:Catheterization / Q000009:adverse effects*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D003131:Combined Modality Therapy; D004322:Drainage / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome