Complications arising from transfemoral, percutaneous implantation of an indwelling port–catheter system for hepatic infusion chemotherapy: Case series of the management and salvage of the system

Abstract

IntroductionRegional hepatic arterial infusion of chemotherapy is performed for unresectable liver tumors via percutaneously implanted port–catheter systems; while these port–catheter systems are effective administration routes, they are associated with various complications. Withdrawal of the system is considered if the complications occur, but repeated hepatic arterial infusion of chemotherapy (HAIC) via an implanted port–catheter system is a last-resort treatment for unresectable advanced liver cancer, and the treatment must be continued. We discuss various cases with complications arising in the indwelling port area in hepatic arterial infusion of chemotherapy and report whether the system was salvaged. MethodsBetween August 2013 and October 2017, eight patients (six males and two females) aged 61–80 years (mean age 76.6 years) with complications arising in a transfemoral indwelling port site for HAIC were referred to our department. All patients requested preservation of the system, especially the catheter. Each patient was assessed for the presence of “gross infection” based on a comprehensive evaluation of clinical findings and blood test results. In cases of “no gross infection,” we performed catheter salvage procedures.If there was no clinical improvement following the catheter salvage procedure, the port–catheter system was withdrawn. This research work has been reported in line with the PROCESS criteria. ResultsThe port–catheter systems were withdrawn in two patients: one due to lasting infection and the other due to ulcer recurrence. Three cases were treated by removal of hematoma through an incision and ointment. The system was withdrawn in one of these cases due to exacerbation of ulcer; thus, the catheters were salvaged in five patients. None of these five patients experienced a relapse from 3 months to over 1 year after the procedure. ConclusionThe success of subcutaneous HAIC significantly impacts a patient’s prognosis, especially for unresectable tumors and residual tumor recurrences. Initially, we chose to preserve the devices without removal, particularly if there was no infection. However, this approach led to a delay in chemotherapy, prolongation of healing time, and additional complications. These cases demonstrate the importance of a thorough consultation with the patient’s oncologist to discuss whether or not the device should be conserved.