KANSERİN METASTATİK DURUMUNUN VE KEMOTERAPİNİN TAMAMEN İMPLANTE EDİLEBİLİR VENÖZ ERİŞİM PORTU AÇIKLIĞI VE PORT İLİŞKİLİ VENÖZ TROMBOEMBOLİK OLAYLAR ÜZERİNE ETKİSİ

Öz

Amaç: Tamamen implante edilebilir venöz erişim portu (TIVAP), kanser hastalarının tedavisinde damar giriş yolu olarak büyük önem taşımaktadır. Bu çalışmada, kanser türlerinin, metastazların, kemoterapötik ilaçların ve girişim bölgelerinin, TIVAP açıklığı ve TIVAP ilişkili venöz tromboembolizm (VTE) üzerindeki etkilerini retrospektif olarak araştırdık. Yöntem: 2017-2021 yılları arasında kliniğimizde TIVAP takılan 297 hasta ve çıkarma işlemi uygulanan 37 hastanın demografik özellikleri, kanser türleri, metastazları, damar girişim bölgeleri, kemoterapi ilaçları, TIVAP patensleri ve TIVAP’a bağlı komplikasyonları değerlendirildi. Bulgular: TIVAP takılan 297 hasta ortalama 17.7±16.6 ay takip edildi. Enfeksiyon 14 (4.7%), okluzyon 8 (2.7%), VTE 9 (3%), malpoziasyon 1 (0.3%) ve tedavi tamamlanması 10 (3.3%) nedenleri ile toplam 37 hastada TIVAP çıkarıldı. 270 (90.9%) hastanın TIVAP’ı ortalama 18.5±17.1 ay süre ile kullanılabilir durumda saptandı. Toplam 71 (23.9%) hastada VTE, okluzyon, enfeksiyon ve malpozisyon komplikasyonları gelişti. Hastalarda metastaz varlığına göre bu komplikasyonların gelişimi karşılaştırıldığında, metastatik hastalarda anlamlı olarak yüksek saptandı (47-%27.9/24-%18.6, p<0.05). Özellikle taksanlar, metotreksat, etoposid ve vinorelbin ile VTE gelişme oranı arasında diğer kemoterapi ilaçlarına kıyasla anlamlı bir pozitif korelasyon saptandı (p<0.05). İleri yaş hastalarda, metastatik kanseri olanlarda ve akciğer kanseri hastalarında TIVAP ile ilişkili VTE oranı anlamlı yüksek saptandı (p<0.05). TIVAP açıklığı, komplikasyonları ve TIVAP ile ilişkili VTE'de venöz giriş yeri ve tarafı açısından anlamlı fark yoktu. Sonuç: Primer kanser, metastazlar ve uygulanan kemoterapi, sistemik veya TIVAP ile ilişkili VTE gelişimi için önemli faktörlerdir. TIVAP ile ilişkili VTE riskini artıran belirli kanser türlerinde, kemoterapi rejimlerinde VTE'nin önlenmesi ve tedavisi için daha fazla çok merkezli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Tamamen İmplante Edilebilir Venöz Erişim Portu
• Venöz Tromboembolizm
• Kanser

Proje Numarası

YOK

THE EFFECTS OF CANCER’S METASTATIC STATUS AND CHEMOTHERAPY ON TOTALLY IMPLANTABLE VENOUS ACCESS PORT PATENCY AND PORT-RELATED VENOUS THROMBOEMBOLIC EVENTS

Öz

Objective: Totally implantable venous access port (TIVAP) is of great importance as a vascular access route in the treatment of cancer patients. In this study, we retrospectively researched the effects of cancer types, metastases, chemotherapeutic drugs, and intervention sites on port patency and TIVAP-related venous thromboembolism (VTE). Method: Demographics, cancer types, metastases, vascular access sites, chemotherapy drugs, TIVAP patency and TIVAP related complications were evaluated in 297 patients who had TIVAP implanted and 37 patients who underwent removal in our clinic between 2017-2021. Results: TIVAP implanted 297 patients were followed-up for a mean 17.7±16.6 months. TIVAPs were removed in 37 patients due to infection 14 (4.7%), occlusion 8 (2.7%), VTE 9 (3%), malposition 1 (0.3%), and treatment completion 10 (3.3%). TIVAPs of 270 (90.9%) patients were found to be usable for an average of 18.5±17.1 months. Complications of VTE, occlusion, infection and malposition developed in a total of 71 (23.9%) patients. In the comparison of develepment of these complications according to the presence of metastasis in patients, it was found to be that they were significantly higher in metastatic patients (47-27.9%/24-18.6%, p<0.05). There was a significant positive correlation between taxanes, methotrexate, etoposide and vinorelbine and the rate of VTE development compared to other chemotherapy drugs(p<0.05). The rate of TIVAP associated VTE was found to be significantly higher in elderly patients, patients with metastatic cancer and patients with lung cancer (p<0.05). No significant difference was present in TIVAP patency, complications and TIVAP-related VTE, in terms of venous access site and side. Conclusion: Primary cancer, metastases, and chemotherapy are important factors for the development of systemic or TIVAP-related VTE. More multicenter studies are needed for the prevention and treatment of VTE in certain types of cancer and chemotherapy regimens that increase the risk of TIVAP-associated VTE.

Anahtar Kelimeler

• Totally Implantable Venous Access Port
• Venous Thromboembolism
• Cancer

Destekleyen Kurum

YOK

Proje Numarası

YOK

Teşekkür

THANKS TO MUGLA SITKI KOCMAN UNIVERSTY/FACULTY OF SCİENCE DEPARTMENT OF STATİSTİCS RESEARCH ASSİSTAN ERSİN YILMAZ FOR THE CONTRIBUTION İN STATISTICAL ANALYSES

Kaynakça

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