To investigate the complications of chemotherapy in patients with breast cancer who received chemotherapy by the totally implantable venous access port(TIVAP).

Totally 3 380 breast cancer patients who received chemotherapy by TIVAP in the First Affiliated Hospital of Chongqing Medical University from July 2013 to April 2018 were enrolled for a retrospective analysis. The incidence of complications was recorded. The occurrence of thrombosis by different approaches of implantation was also analyzed. The goodness-of-fit test was used to compare the incidence of complications including re-extraction without blood return, asymptomatic catheter-related thrombosis, symptomatic catheter-related thrombosis, catheter-related infection, exposure of port, catheter dislocation, drug extravasation, rupture or shedding of catheter. χ² test was used to compare the thrombosis rate by different approaches of implantation.

Among the 3 380 patients, 3 255 patients were implanted with TIVAP via the internal jugular vein, 77 via the basilic vein, 40 via the axillary vein, 4 via the subclavian vein and 4 via the femoral vein. The operation was on the left side in 1 491 cases, on the right side in 1 889 cases. The time of indwelling catheter was (136.6±39.1) d, at the range of 51.0-940.0 d. A total of 1 588 patients had complications in this study, with a complication rate of 47.0% (1 588/3 380). The results of goodness-of-fit test showed that all complications were not subject to proportional distribution, and the proportion of asymptomatic catheter-related thrombosis was the highest (73.3%, 1 164/1 588) (χ²=5 590.217, P<0.001). The thrombosis rate was 36.7% (1 195/3 255) for the implantation via the internal jugular vein, 3.9% (3/77) via the basilic vein and 2.5% (1/40) via the axillary vein. No thrombosis was observed via the femoral vein (n=4) or subclavian vein (n=4). The thrombosis rate was significantly different among the patients treated by different implantation approaches (χ²=74.460, P<0.001), and the thrombosis rate by the implantation approach via internal jugular vein was significantly higher than that via the basilic vein or axillary vein (all P<0.050). The thrombosis rate was 41.5% (594/1 433) and 33.0% (601/1 822) via the left and right internal jugular vein, respectively, indicating a significant difference (χ²=24.742, P<0.001).

The proportion of catheter-related thrombosis is the highest of all complications when TIVAP is used for chemotherapy. In order to reduce the risk of catheter-related thrombosis, the approach via the basilic vein and axillary vein can be adopted if the patient has no contraindication. Then the right internal jugular vein is preferred for the implantation of TIVAP for chemotherapy and the catheter-related thrombosis should be prevented with caution.