Tailored approach to the choice of long-term vascular access in breast cancer patients

Comparison between arm port and chest port: A systematic review and meta-analysis

OBJECTIVE

This meta-analysis aimed to compare the efficacy and safety of arm ports (APs) and chest ports (CPs) in clinical practice.

METHODS

Randomized controlled trials (RCTs), controlled clinical trials, and retrospective studies were searched in both English and Chinese databases, encompassing PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Database, and SinoMed up to November 27, 2023. Data analysis was performed using Stata 15.0.

RESULTS

Seventeen studies, including two RCTs, three cohort studies, and twelve case-control studies, were finally included, involving a total of 4168 participants, with 2151 participants in the CP group and 2017 in the AP group. The meta-analysis showed that there was no significant difference between CP and AP in the incidence rates of infections [OR = 0.98, 95% CI (0.68, 1.41)], catheter occlusion[OR = 0.95, 95% CI (0.55, 1.64)], thrombosis [OR = 0.85, 95% CI (0.60, 1.21)], exudation [OR = 1.32, 95% CI (0.52, 3.36)], fibrin sheath [OR = 1.68, 95% CI (0.46, 6.19)], catheter malposition [OR = 0.62, 95% CI (0.30, 1.29)], fracture[OR = 1.84, 95% CI (0.49, 6.96)], pneumothorax [OR = 5.73, 95% CI (0.94, 35.11)], and malfunction [OR = 1.87, 95% CI (0.65, 5.42)].

CONCLUSION

This study reveals no significant differences in the incidence of infections, catheter occlusion, thrombosis, exudation, fibrin sheath, catheter malposition, fracture, pneumothorax, and malfunction between the two implanted venous access ports. Thus, it can be concluded that AP is as safe as CP.

Vascular access devices for prolonged intravenous therapy regimens in people diagnosed with cancer

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the relative effectiveness and vascular access device (VAD)-related complications of VADs in people requiring prolonged systemic anti-cancer treatment.

A retrospective cohort study of implantable venous access port-related and peripherally inserted central catheter-related complications in patients with hematological malignancies in China

Objective

We explored the differences in deep venous catheterization-associated complications between patients with hematological malignancies after peripherally inserted central catheter placement and such patients after implantable venous access port catheterization.

Introduction

peripherally inserted central catheters and implantable venous access ports are the most popular devices used for chemotherapy. However, no study has revealed differences between peripherally inserted central catheters and implantable venous access ports in Chinese patients with hematological malignancies.

Methods

The clinical data of 322 patients with hematological malignancies who were treated from January 1, 2020 to December 30, 2021 were included in a retrospective cohort study. Postoperative color Doppler ultrasonography and follow-up results were used to compare the incidence rates of deep venous catheterization -associated complications after peripherally inserted central catheters and implantable venous access ports catheterization.

Results

The relative risk of catheter-related complications considering the type of device was 8.3 (95% CI = 3.0-22.8). In addition, chi-square segmentation analysis revealed a significant difference in the complication rate between the internal jugular vein and the basilic vein (χ2 = 22.002, p < 0.0001) and between the subclavian vein and the basilic vein (χ2 = 28.940, p < 0.0001).

Conclusion

Implantable venous access ports are safer than peripherally inserted central catheters for Chinese patients with hematological malignancies. The implantation of implantable venous access ports could be firstly considered for systematic anti-cancer treatment.

Peripherally inserted central catheters versus implantable port catheters for cancer patients: a meta-analysis

Background

The implanted vascular access ports (PORTs) were compared with peripherally inserted central catheters (PICCs) as the administration of chemotherapy regarding different clinical effects and adverse effects. Which is better is debatable. Hence, the current study was conducted to assess the safety and efficacy of these two optimal vascular access strategies.

Methods

The following electronic databases were searched: PubMed, Embase, and the Cochrane Library updated in May 2023. Studies on the differences in complication rates in patients with cancer using either PICC or PORT for chemotherapy were included. Meta-analysis Revman 5.3 software was used for statistical analysis.

Results

A total of 22 articles were retrieved. The results suggested that PORT has a superior safety profile, with lower incidences of overall adverse effects (OR=2.72, 95% CI=1.56-4.72 P=0.0004), catheter-related thrombosis (OR=2.84, 95% CI=1.97-4.11, P<0.00001), and allergic reactions (OR=6.26, 95% CI=1.86-21.09, P=0.003) than typically expected with PICC. Moreover, PICC was non-inferior to the PORT group with respect to DVT (OR=2.00, 95% CI=0.86-4.65, P=0.11) and infection (OR=1.55, 95% CI=0.75-3.22, P=0.24).

Conclusion

PORT achieved safety benefits compared with chemotherapy through PICC. Therefore, PORT is regarded as safe and effective vascular access for the administration of chemotherapy. When considering economic factors and some key elements, more high-quality research would help verify these clinical benefits.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identififier CRD42023421690.