Higher complication risk of totally implantable venous access port systems in patients with advanced cancer – a single institution retrospective analysis

1. Yi-Fang Chang
   1. Department of Haematology and Oncology, Mackay Memorial Hospital, Taipei, Taiwan
   2. Good Clinical Research Centre, Mackay Memorial Hospital, Taipei, Taiwan
2. An-Chi Lo
   1. Good Clinical Research Centre, Mackay Memorial Hospital, Taipei, Taiwan
3. Chung-Hsin Tsai
   1. Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
4. Pei-Yi Lee
   1. Department of Nursing, Mackay Memorial Hospital, Taipei, Taiwan
5. Shen Sun
   1. Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
6. Te-Hsin Chang
   1. Department of Nursing, Mackay Memorial Hospital, Taipei, Taiwan
7. Chien-Chuan Chen
   1. Department of Anaesthesia, Mackay Memorial Hospital, Taipei, Taiwan
8. Yuan-Shin Chang
   1. Department of Haematology and Oncology, Sijhih Cathay General Hospital, Taipei, Taiwan
9. Jen-Ruei Chen
   1. Department of Obstetrics and Gynaecology, Mackay Memorial Hospital, Taipei, Taiwan

1. Yi-Fang Chang, M.D., No. 92, Section 2, Zhongshan N. Road, Zhongshan District, Taipei City 10449, Taiwan. Email: changyifang@gmail.com

Abstract

Background: Totally implantable port systems are generally recommended for prolonged central venous access in diverse settings, but their risk of complications remains unclear for patients with advanced cancer.

Aim: 

The aim of this study was to assess the risk of port system failure in patients with advanced cancer.

Design: We conducted a retrospective cohort study in a comprehensive cancer centre.

Setting/participants: A detailed chart review was conducted among 566 patients with 573 ports inserted during January–June, 2009 (average 345.3 catheter-days). Cox regression analysis was applied to evaluate factors during insertion and early maintenance that could lead to premature removal of the port systems due to infection or occlusion.

Results: Port system-related infection was significantly associated with receiving palliative care immediately after implantation (hazard ratio, HR = 7.3, 95% confidence interval, 95% CI = 1.2–46.0), after adjusting for probable confounders. Primary cancer site also impacted the occurrence of device-related infection. Receiving oncologic/palliative care (HR = 3.0, P = 0.064), advanced cancer stage (HR = 6.5, P = 0.077) and body surface area above 1.71 m² (HR = 3.4, P = 0.029) increased the risk of port system occlusion. 

Conclusions: 

Our study indicates that totally implantable port systems yield a higher risk of complications in terminally ill patients. 

 Further investigation should be carefully conducted to compare outcomes of various central venous access devices in patients with advanced cancer and to develop preventive strategies against catheter failure.

• catheters/indwelling/adverse effects
• central venous access
• oncologic care
• palliative care/methods
• totally implantable ports