Implantable port placement in patients at risk of lymphedema

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There was no difference in port complications or lymphedema rates between patients who had ports placed on the ipsilateral side compared with the contralateral side for breast cancer treatment” Isom et al (2019).

Abstract:

BACKGROUND: Central venous ports placed for breast cancer treatment have traditionally been placed contralateral to the disease. This is done out of concern for the possibility of an increased risk of complications with ipsilateral port placement. There have been only a few small studies evaluating complication rates between ports placed ipsilateral versus contralateral to the breast cancer. We sought to determine if there was a difference in port complications or lymphedema rates by location.

METHODS: A single institution retrospective review was conducted of adult (aged >18 y) females undergoing central venous port placement for breast cancer treatment from 2012 to 2016.

RESULTS: A total of 581 females were identified with a mean age of 52.9 ± 11.7 y. Ipsilateral ports were placed in 41 patients (7.1%). Ipsilateral ports were more likely to be placed via the internal jugular vein (56.1%), whereas contralateral ports were more likely to be placed in the subclavian vein (67.2%; P = 0.002). There was no difference between stage at diagnosis (P = 0.059), type of breast surgery (P = 0.999), axillary surgery (P = 0.087), or administration of radiation therapy (P = 0.684) between the groups. Ipsilateral ports were more likely to be on the right side, 73.2% versus 51.1% (P = 0.006). Port complications requiring intervention occurred in 3 patients (7.3%) with ipsilateral port and 33 patients (6.1%) with contralateral ports (P = 0.73). Lymphedema occurred in 8 patients (20%) with ipsilateral ports and 118 patients (21.9%) with contralateral ports (P = 0.639). On multivariable analysis, the type of axillary surgery (P = 0.003) was associated with upper extremity lymphedema, whereas port sidedness (P = 0.26) was not.

CONCLUSIONS: There was no difference in port complications or lymphedema rates between patients who had ports placed on the ipsilateral side compared with the contralateral side for breast cancer treatment.

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Reference:

Isom, C., Bream, P. Jr., Gallagher, K., Walia, S., Ahmed, R. and Kauffmann, R. (2019) Placement of Subcutaneous Central Venous Ports in Breast Cancer Patients: Does Side Matter? The Journal of Surgical Research. July 11th. doi: 10.1016/j.jss.2019.06.028. .

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