Totally implante edilebilir venöz kateter (TIVAD) uygulanan kanser hastalarında erken ve geç komplikasyonlar ile port çıkarımını öngören faktörler: tek merkezli retrospektif bir çalışma

Abstract

ÖZET Amaç: Subkütan yerleştirilen totally implantable venöz erişim cihazları (TIVAD), kanser hastalarında uzun süreli intravenöz tedavilerin uygulanmasında yaygın olarak kullanılmaktadır. Ancak bu sistemler, cihazın çıkarılmasını gerektirebilecek erken ve geç dönem komplikasyonlarla ilişkili olabilir. Bu çalışmada, onkoloji hastalarında port kateter implantasyonuna bağlı gelişen komplikasyonların insidansı ve klinik özelliklerinin değerlendirilmesi ile port çıkarımıyla ilişkili risk faktörlerinin belirlenmesi amaçlanmıştır. Yöntemler: Bu retrospektif, tek merkezli çalışmaya Ocak 2022 ile Temmuz 2024 tarihleri arasında subkütan port kateteri yerleştirilen 313 erişkin kanser hastası dahil edildi. Tüm işlemler lokal anestezi altında, ultrasonografi ve floroskopi rehberliğinde çift insizyon tekniği kullanılarak gerçekleştirildi. Hastalar erken (<30 gün) ve geç (≥30 gün) komplikasyonlar açısından takip edildi. Port çıkarımıyla ilişkili faktörler univaryant ve multivaryant lojistik regresyon analizleri ile değerlendirildi. Bulgular: Hastaların ortalama yaşı 62,45±7,75 yıl olup, en sık görülen maligniteler kolorektal (%45,0), mide (%25,9) ve pankreas kanseri (%8,9) idi. Erken komplikasyonlar %3,2 oranında, geç komplikasyonlar ise %25,6 oranında gözlendi. En sık görülen komplikasyonlar enfeksiyon (%8,3), kateter disfonksiyonu (%4,8) ve venöz tromboz (%3,8) idi. Toplam 66 hastada (%21,1) port çıkarımı gerekli oldu; en yaygın nedenler lokal enfeksiyon (%6,1), tıkanıklık (%4,8), cilt erozyonu (%5,4) ve kateter ilişkili kan dolaşımı enfeksiyonu (CRBSI) (%2,2) idi. Univaryant analizde düşük vücut kitle indeksi, metastaz, kemoterapi ve çeşitli komplikasyonlarla port çıkarımı arasında anlamlı ilişkiler bulundu (p<0,05). Multivaryant analizde, metastatik hastalık bağımsız bir risk faktörü olarak belirlendi (OR: 10,14; p<0,001), ileri yaş ise port çıkarımı ile ters yönde ilişkiliydi (OR: 0,95; p=0,021). Sonuç: TIVAD ile ilişkili komplikasyonlar yaygındır ve özellikle metastatik kanser hastalarında sıklıkla port çıkarımına yol açabilir. Enfeksiyon ve mekanik disfonksiyon, çıkarımın başlıca nedenleridir. Yüksek riskli hastalarda dikkatli takip ve bireyselleştirilmiş önleyici stratejiler, portun uzun dönemli işlevselliğini artırabilir.

Keywords

• Kanser hastaları
• Komplikasyonlar
• Port çıkarımı
• Tam implante edilebilir venöz erişim cihazı
• Venöz port kateteri.

Early and late complications and predictors of port removal in cancer patients with totally implantable venous access devices (TIVADs): a single-center retrospective study

Abstract

Aims: Totally implantable venous access devices (TIVADs), placed subcutaneously, are widely used in cancer patients for the administration of long-term intravenous therapies. However, these systems may be associated with early and late complications that can necessitate device removal. This study aimed to evaluate the incidence and clinical characteristics of complications related to port catheter implantation in oncology patients, and to identify risk factors associated with port removal. Methods: In this retrospective, single-center study, 313 adult cancer patients who underwent subcutaneous port catheter implantation between January 2022 and July 2024 were included. All procedures were performed under local anesthesia using a dual-incision technique with ultrasound and fluoroscopy guidance. Patients were monitored for early (<30 days) and late (≥30 days) complications. Factors associated with port removal were analyzed using univariate and multivariate logistic regression models. Results: The mean age of the patients was 62.45±7.75 years, with the most common malignancies being colorectal (45.0%), gastric (25.9%), and pancreatic cancers (8.9%). Early complications were observed in 3.2% of patients, while late complications occurred in 25.6%. The most frequent complications included infection (8.3%), catheter dysfunction (4.8%), and venous thrombosis (3.8%). Port removal was required in 66 patients (21.1%), most commonly due to local infection (6.1%), occlusion (4.8%), skin erosion (5.4%), and catheter-related bloodstream infection (CRBSI) (2.2%). Univariate analysis revealed significant associations between port removal and low body-mass index, metastasis, chemotherapy, and several complications (p<0.05). In multivariate analysis, metastatic disease was identified as an independent risk factor (OR: 10.14; p<0.001), while advanced age was inversely associated with port removal (OR: 0.95; p=0.021). Conclusion: Complications related to TIVADs are common and may frequently lead to port removal, especially in metastatic cancer patients. Infection and mechanical dysfunction are the leading causes of removal. Careful follow-up and individualized preventive strategies in high-risk patients may improve long-term port functionality.

Keywords

• Cancer patients
• complications
• port removal
• totally implantable venous access device
• venous port catheter

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