title: Complication-related removal of totally implantable venous access port systems: Does the interval between placement and first use and the neutropenia-inducing potential of chemotherapy regimens influence their incidence? A four-year prospective study of 4045 patients.
abstract: BACKGROUND
  Totally implantable venous access port systems are widely used in oncology, with frequent complications that sometimes necessitate device removal. The aim of this study is to investigate the impact of the time interval between port placement and initiation of chemotherapy and the neutropenia-inducing potential of the chemotherapy administered upon complication-related port removal.
  
  
  METHODS
  Between January 2010 and December 2013, 4045 consecutive patients were included in this observational, single-center prospective study. The chemotherapy regimens were classified as having a low (<10%), intermediate (10-20%), or high (>20%) risk for inducing neutropenia.
  
  
  RESULTS
  The overall removal rate due to complications was 7.2%. Among them, port-related infection (2.5%) and port expulsion (1%) were the most frequent. The interval between port insertion and its first use was shown to be a predictive factor for complication-related removal rates. A cut-off of 6 days was statistically significant (p = 0.008), as the removal rate for complications was 9.4% when this interval was 0-5 days and 5.7% when it was ≥6 days. Another factor associated with port complication rate was the neutropenia-inducing potential of the chemotherapy regimens used, with removal for complications involved in 5.5% of low-risk regimens versus 9.4% for the intermediate- and high-risk regimens (p = 0.003).
  
  
  CONCLUSIONS
  An interval of 6 days between placement and first use of the port reduces the removal rate from complications. The intermediate- and high-risk for neutropenia chemotherapy regimens are related to higher port removal rates from complications than low-risk regimens.
authors.affiliation: Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France. Electronic address: athanasios.kakkos@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Kakkos
authors.affiliation: Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Bresson
authors.affiliation: Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Hudry
authors.affiliation: Department of Medical Oncology, Centre Régional de Lutte Contre le Cancer Institut Bergonié, 229 Cours de l' Argonne, 33076 Bordeaux Cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Cousin
authors.affiliation: Department of Pediatric Oncology, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Lervat
authors.affiliation: Department of Methodology and Biostatistics, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Bogart
authors.affiliation: Department of Methodology and Biostatistics, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Meurant
authors.affiliation: Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: El Bedoui
authors.affiliation: Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Decanter
authors.affiliation: Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France.
authors.forename: K
authors.initials: K
authors.lastname: Hannebicque
authors.affiliation: Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Regis
authors.affiliation: Department of Anesthesiology and Reanimation, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Hamdani
authors.affiliation: Department of Medical Oncology, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Penel
authors.affiliation: Department of Methodology and Biostatistics, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Tresch-Bruneel
authors.affiliation: Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Narducci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D061807:Catheter Obstruction / Q000706:statistics & numerical data; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D020878:Device Removal / Q000706:statistics & numerical data*; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D005548:Foreign-Body Migration / Q000453:epidemiology*; D006406:Hematoma / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D019919:Prosthesis Implantation; D013927:Thrombosis / Q000453:epidemiology; D062666:Vascular Access Devices; D055815:Young Adult
keywords: Interval insertion-first use; Neutropenia-inducing potential of chemotherapy; Removal for complications; Totally implantable venous access port systems