Impact of chest subcutaneous fat on the occurrence of central venous port-related infectious complications in cancer patients

Takuya Arakawa,Takehito Kato,Hidetaka Kawamura,Kojiro Omiya,Kenta Ishii,Masahiro Fujii,Michitaka Honda,Kento Kawashima,Takuya Hasegawa,Hirotake Gonda,Taro Aoba,Shuhei Asai,Yoshihisa Shibata,Kazuhiro Hiramatsu,Atsuki Arimoto,Akira Ito,Jumpei Shibata,Mariko Asai

doi:10.1007/s00520-021-06109-9

Abstract

PurposeThere is no concrete evidence to support the association between the amount of subcutaneous fat area (SFA) in the central venous port-insertion site (precordium) and port-related complications. We aimed to investigate the relationship between SFA in the midclavicular line and postoperative infectious complications in patients undergoing port-insertion surgery.MethodsThis was a single-institute and historical cohort study of 174 patients who underwent first central venous port implantation surgery for chemotherapy between January 2014 and December 2018. SFA in the midclavicular line was measured using preoperative computed tomography scans. The patients were divided into three groups according to SFA amount tertiles, and we investigated the association of SFA with infectious and all-cause complication events within 1 year.ResultsWithin a median follow-up of 306 days, the patients with intermediate SFA had significantly higher infection-free survival than those with low and high SFA (low vs. intermediate vs. high: 80.4% vs. 97.7% vs. 83.4%, respectively, p=0.034). In contrast, there was no significant difference in the overall complication-free survival among the groups (low vs. intermediate vs. high: 80.4% vs. 88.9% vs. 81.8%, respectively, p=0.29). Low SFA was independently associated with high risk of infectious complications (hazard ratio, 9.45; 95% confidence interval, 1.07–83.22, p=0.043).ConclusionLow SFA in the midclavicular line was an independent risk factor for infectious complications in the chemotherapy setting. This practical indicator can be useful for optimizing patients’ nutritional status and when considering other types of vascular access to support administration of intravenous chemotherapy.

Highlights

The central venous (CV) port system has become an essential device that facilitates long-term administration of chemotherapy
We aimed to evaluate the association between subcutaneous fat in the midclavicular line and port-related infectious complications in adult patients undergoing CV port insertion for chemotherapy
There were no significant differences in other baseline characteristics, including Charlson comorbidity index (CCI), American Society of Anesthesiologists performance status (ASA-PS), serum lymphocyte counts, serum albumin level, grade of surgeon, access side, and access site

Summary

Introduction

The central venous (CV) port system has become an essential device that facilitates long-term administration of chemotherapy. Support Care Cancer (2021) 29:5391–5398 low subcutaneous fat in the port-insertion site might be a potential risk factor for port-related infectious complications, no study has reported an association between the subcutaneous fat area (SFA) and port-related infection. In comparison, computed tomography (CT)–derived analytic imaging of body composition may lead to a more specific assessment of infection risk at the operative site [4]. In CV port insertion, this objective measurement may potentially reflect the surgeons’ preoperative subjective assessment of the operative site of the SFA in the midclavicular line. Within this context, we speculate that applying these objective surgical site assessment measures might inform preoperative risk evaluation and contribute to clinical decision-making

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