Complications d’un dispositif intraveineux implantable pour chimiothérapie dans les cancers des voies aérodigestives supérieures

Abstract

Objectives To review the occurrence of early and delayed complications after insertion of a totally implantable venous access port (Tivap) in patients treated with chemotherapy for head and neck squamous cell carcinoma. Material and methods Monocentric prospective study (2005–2008) undertaken in a tertiary referral center. In all cases, the inserted Tivap was a Celsite ST301 (Braun ®) model. The insertion procedure was performed in operating room conditions under local anesthesia using a surgical cut-down method. No antibiotic prophylaxis or long-term anticoagulant medications were administered. Two groups were made between experienced and in-training surgeons. All complications occurring from the date of Tivap insertion to the date of its removal or until the closure of the study were included. Results The study comprised of 122 patients including 103 males and 19 females; the patients’ mean age was 58.5 years (range, 36–80). Twelve (9.8%) had a tracheotomy or tracheostomy and 41 (33.6%) underwent cervical radiotherapy before Tivap insertion. In 63 cases (51.6%), the procedure was performed by a senior surgeon. The inserted vessel was the cephalic vein (84.4%), the external jugular vein (11.5%) or the internal jugular vein (2.5%). Overall, the total number of days of Tivap implantation was 51,403. Altogether, 11 complications (9%) were listed: two (1.6%) early complications and nine (7.4%) delayed complications. We did not uncover a significant statistical relation between complication onset and experience of the operating surgeon, sex, implanted side, tracheotomy, previous radiotherapy, or number of days of Tivap port. Conclusion Our study suggests that: (1) complications are rare provided careful implantation and manipulation methods are followed by health personnel; (2) surgical cephalic cut-down is a very reliable method; and 3) antibiotic prophylaxis or long-term anticoagulant medications are not mandatory.