12-Years Experience of Implanted Venous Access Port Systems in Children with Cancer in a Multidisciplinary Hospital: Cross-Sectional Study

Abstract

Background. Advances in oncology and hematology-oncology are associated with the development of advanced treatment programs. The main role among them one belongs to chemotherapy. Therapy requires adequate venous access and the most optimal is a fully-implantable venous system (venous port) that meets all the requirements for long-term and intermittent administration of drugs. Objective. The aim of our study was to analyze the experience of using IVAPS in the treatment of children with cancer in a multidisciplinary hospital. Methods. A retrospective study of the implantation of 192 IVAPS in children in the Morozovskaya State Children’s Clinical Hospital for 12 years from 2004 to 2015 was conducted. The average age of patients at the time of implantation is 53 months — 4 years and 4 months. The ratio by gender was equal. IVAPS were implanted under X-ray control in a surgery room by puncture technique in the subclavian and / or jugular veins mainly in patients with solid tumors (175/192; 91,2%), and with hemoblastomas (17/192; 8,8%). Results. The average lifetime of the IVAPS is 24 months. Intraoperative complications and complications in the short term (up to 30 days from the moment of implantation) were noted in 44/192 (23%) cases, in the long term (more than 30 days) — in 34/192 (17.7%). All intraoperative complications were resolved during surgery. In the long-term period, infection of the IVAPS was detected in 12 (6.25%) cases: gram-positive flora in 7/12 (58.3%) cases, gram-negative flora in 5/12 (41.7%); in 17/192 (8.9%) — thrombosis of the IVAPS, in 2/192 (1%) — violation of the integrity of the port-system. IVAPS were removed in 78/192 (40.6%) cases: due to the end of treatment — 66/78 (84.6%), due to infection — 12/78 (15.4%). 45/191 (23.6%) patients died from progression of the underlying disease, 89/191 (46.6%) achieved remission, 32/191 (16.8%) continue treatment, 25/191 (13.1%) dropped out from under observation. Conclusion. Considering the intensification of treatment protocols, it is reasonable to recommend the use of IVAPS in the treatment of children with cancer.