Comparison between Arm Port and Chest Port for Optimal Vascular Access Port in Patients with Breast Cancer: A Systematic Review and Meta-Analysis

Abstract

Objectives. This meta-analysis was conducted to compare the complication rates between arm and chest ports in patients with breast cancer. Design and Data Sources. PubMed, Embase, Cochrane library, Chinese National Knowledge Infrastructure (CNKI), and Wanfang database were used to perform a systematic review and meta-analysis of publications published from the inception of the database to 11, October 2019. Our search generated a total of 22 articles published from 2011 to 2019, including 6 comparative studies and 16 single-arm articles, involving 4131 cases and 5272 controls. Single-arm studies combined with comparative studies were also pooled and analyzed. Finally, subgroup analysis was performed to compare the rates of infection and thrombosis between these two ports. Eligibility Criteria. Included articles were research studies comparing complication rates of arm ports with chest ports in patients with breast cancer. Any review or meta-analysis article would be removed. Data Extraction and Synthesis. Demographic data and information for the following analysis were extracted. DerSimonian and Laird random effect meta-analysis was conducted to analyze comparative studies while Begg’s and Egger’s tests were used for assessment of publication bias. Meta-regression analysis was performed to explain the sources of heterogeneity. Results. There was no difference in the risk of overall complications between arm and chest ports for comparative studies (P=0.083). While results of pooled comparative and single-arm studies indicated that arm port would increase the overall complication risks with RR of 2.64, results of the subgroup analysis showed that there was no difference in the risk of catheter-related infection between these two ports. However, arm port might be associated with the higher thrombosis rates compared with chest port according to the results of the analysis for only comparative studies (RR = 2.23, P=0.041) as well as pooled comparative and single-arm studies (RR = 1.21, P=0.029). Conclusions. This study indicated that the arm port might increase the risk of overall complication risks as well as the risk of catheter-related thrombosis compared with the chest port. However, these reported findings still need to be verified by large randomized clinical trials.

Safety of Insertion of Percutaneous Totally Implantable Central Venous Access Devices by Surgical Residents

“…With the increasing number of patients with cancer, physicians have shown interest in TIVAD insertion using a percutaneous approach (17). The selection of venous sites and approaches for TIVAD have already been discussed in literature (18)(19)(20)(21)(22). According to a 27-year comprehensive review of TIVAD insertion, a cut-down manoeuvre was not the predominantly used approach (42.8%) (18).…”

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

“…These indwelling vascular accesses enable the delivery of chemotherapeutic drugs or blood products and can be used for blood draws, avoiding the possible local complications associated with the extravasation of cytotoxic drugs [6,7]. Each approach has different safety and risk profiles as well as effects on the patient's quality of life [8,9]. The rate of major complications from TIVADs including both chest and arm ports ranged from 3.5 to 19% in previous studies [10][11][12].…”

2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19

“… 71 One meta-analysis of 22 studies (4131 cases, 5272 controls) in patients with breast cancer showed that arm ports were associated with a higher VTE risk than chest ports (RR 2·23, 95% CI 1·04–4·79; p=0·041). 72 In one randomised controlled trial (399 patients), peripherally inserted central catheters were associated with a higher risk of VTE and adverse events than implanted port catheters (HR 10·2, 95% CI 2·3–44·6, p=0·0002). 73 Another prospective, non-randomised study of 423 patients treated with chemotherapy via a peripherally inserted central catheter reported substantially lower rates of upper extremity VTE when patients received prophylaxis with rivaroxaban (10 mg daily; 3·76%) or enoxaparin (40 mg daily; 3·03%), compared with no prophylaxis (12·4%).…”