Totally Implantable Venous Access Port Systems: Implant Depth-based Complications in Breast Cancer Therapy - A Comparative Study

Background: Totally implantable venous access port system (TIVAPS) is widely used in breast cancer therapy; TIVAPS has several associated complications depending on the depth of implantation in breast cancer (BC) patients during continuous infusional chemotherapy regimens. The purpose of this study is to find out the optimal depth of TIVAPS implantation to reduce the incidence of complications during infusional chemotherapy. Methods: This study reviewed the depth of TIVAPS implantation in the internal jugular vein in 1282 breast cancer patients over a ten-year period (2009-2019), and associated complications. We segregated the patients as 5 groups: ‘Group A (depth < 4 mm), Group B (depth of 4-8 mm), Group C (depth of 8-12 mm), and Group D (depth of 12-16 mm), and Group E (depth of > 16 mm)’. Consequently, the ‘internal complications’ such as infection, venous thrombotic syndrome, catheter folding & migration, extravasation, whereas the ‘external complications’ viz., inflammation, local hematoma, local cutaneous reactions, and port exteriorization were significantly analyzed during TIVAPS implantation at different depths in BC patients. Results: Overall incidence of ‘internal complications’ such as infections (8.6%, 2/23 cases), venous thrombotic syndrome (7.69%, 1/13 cases), catheter folding & migration (8.3%, 1/12 cases), and extravasation (8.3%, 1/12 cases) was comparatively lesser in Group C (8-12 mm) (p<0.01) than the Group A, Group B, Group D, and Group E respectively. Mainly, the external complications such as inflammation in Group C (8-12 mm) (pp< 0.01) was lesser (6.8%, 3/44 cases) than Group A, Group B, Group D, Group E. On the similar note, the local hematoma, and local cutaneous reaction, and port exteriorization were observed as ‘5% (1/20 cases), 4.2% (2/47 cases), and (3.2%, 1/31 cases)’ in Group C patients (p<0.01), which were comparatively lesser than the other groups. Conclusion: Subcutaneous implantation of TIVAPS at a depth of 8-12 mm could be preferred due to the lowest incidence of internal and external complications compared to the incidence of these complications in other groups; this depth could be referred to as the safe and convenient implantation depth for the effective delivery of chemotherapy regimen in BC patients without difficulty in transcutaneous access to the port.