Implantable Central Venous Access Ports Placed in Mastectomy Incision Sites: A Safe and Viable Option

Implantable Central Venous Access Ports Placed in Mastectomy Incision Sites: A Safe and Viable Option The requirement for central venous access port (CVAP) placement for chemotherapy administration is, in some breast cancer cases, identified preoperatively based on tumor markers or stage. Several studies have looked at complications that occur with these devices.14 These commonly include infections, port migration or malfunction, and catheter-related thrombosis. Presently, there are no reports in the literature that have evaluated implantable CVAP placement at the time of mastectomy within the mastectomy incision, despite some practical advantages to this placement technique. For patients undergoing bilateral mastectomies, there is no anterior chest alternative for port placement other than in one of the mastectomy sites. If the patient is undergoing immediate reconstruction, a separate counter incision for CVAP removal is not necessary because the device could be removed at the second-stage surgery through the mastectomy incision. This avoids a separate incision at the superior aspect of the chest, thereby improving the end cosmetic result. The purpose of this study was to determine if placement of implantable CVAPs via a mastectomy incision increases the risk of catheter-related infection. This study was reviewed and approved for implementation by the Institutional Review Board of the University of Kansas School of Medicine Wichita. A retrospective chart review was conducted to evaluate the outcomes of 343 female breast cancer patients who had implantable CVAPs placed by two practicing surgeons between January 1, 2009, and December 31, 2011. Data collected included patient age, medical comorbidities, CVAP placement site (mastectomy incision vs separate incision), CVAP removal, reason for CVAP removal, and CVAP-related complications. Medical comorbidities collected were of those known to be associated with CVAP complications, including diabetes mellitus, smoking, and obesity. Continuous variables were compared using Student’s t test for independent samples. Categorical data were compared using chi-squared analysis or the Fisher’s exact test in instances when cell size was 5 or less observations. All tests were two tailed and a P < 0.05 was considered statistically significant. All statistical analyses were conducted using SPSS software, version 19.0 (IBM Corp., Somers, NY). Of the 343 patients that met inclusion criteria, 67 had a CVAP placed in their mastectomy incision and 276 in a separate incision. Women who received their CVAP via their mastectomy incision were significantly younger than those receiving their CVAP through a separate incision (Table 1). Comorbidities typically associated with CVAP complications were similar between the groups (Table 1). On average, CVAPs were left in place for 15.9 months (range 1–60). A total of 21 CVAPs (6.1%) were removed due to complications (Table 2). Overall complication rate was significantly higher in the mastectomy incision group (11.9 vs 4.7%, P 4 0.027). However, no significant differences were identified when comparing individual complications. There was no significant difference between the two groups when comparing rate of removal of CVAPs due to port malfunction. A malfunctioning CVAP was the most common reason for removal in both groups. There were a total of 13 malfunctioning CVAPs, 7 (53.8%) of which were associated with tissue expander placement. The remaining 6 (46.2%) were in patients who did not undergo immediate reconstruction. Malfunctioning CVAPs consisted of CVAPs that could no longer be infused or aspirated. Infections resulting in CVAP removal were also not different between mastectomy and separate incision groups (4.5 vs 1.4%, respectively; P 4 0.138). Neither pain nor chemotherapy extravasation was found to be the indication for premature CVAP removal in our study population. Only one CVAP in the separate incision group was found to be malpositioned, resulting in the need for removal. Address correspondence and reprint requests to Jacqueline S. Osland, M.D., Department of Surgery, Room 3082, University of Kansas School of Medicine, 929 N. Saint Francis Street, Wichita, KS 67214. E-mail: jackieo11165@gmail.com.