Early and late complications and predictors of port removal in cancer patients with totally implantable venous access devices (TIVADs): a single-center retrospective study

Aims: Totally implantable venous access devices (TIVADs), placed subcutaneously, are widely used in cancer patients for the administration of long-term intravenous therapies. However, these systems may be associated with early and late complications that can necessitate device removal. This study aimed to evaluate the incidence and clinical characteristics of complications related to port catheter implantation in oncology patients, and to identify risk factors associated with port removal. Methods: In this retrospective, single-center study, 313 adult cancer patients who underwent subcutaneous port catheter implantation between January 2022 and July 2024 were included. All procedures were performed under local anesthesia using a dual-incision technique with ultrasound and fluoroscopy guidance. Patients were monitored for early (<30 days) and late (≥30 days) complications. Factors associated with port removal were analyzed using univariate and multivariate logistic regression models. Results: The mean age of the patients was 62.45±7.75 years, with the most common malignancies being colorectal (45.0%), gastric (25.9%), and pancreatic cancers (8.9%). Early complications were observed in 3.2% of patients, while late complications occurred in 25.6%. The most frequent complications included infection (8.3%), catheter dysfunction (4.8%), and venous thrombosis (3.8%). Port removal was required in 66 patients (21.1%), most commonly due to local infection (6.1%), occlusion (4.8%), skin erosion (5.4%), and catheter-related bloodstream infection (CRBSI) (2.2%). Univariate analysis revealed significant associations between port removal and low body-mass index, metastasis, chemotherapy, and several complications (p<0.05). In multivariate analysis, metastatic disease was identified as an independent risk factor (OR: 10.14; p<0.001), while advanced age was inversely associated with port removal (OR: 0.95; p=0.021). Conclusion: Complications related to TIVADs are common and may frequently lead to port removal, especially in metastatic cancer patients. Infection and mechanical dysfunction are the leading causes of removal. Careful follow-up and individualized preventive strategies in high-risk patients may improve long-term port functionality.