Factors associated with central venous port implantation during breast cancer perioperative chemotherapy: a Japanese database study

Vascular access guidelines in Western countries recommend the central venous (CV) administration of cytotoxic chemotherapy agents to reduce complications such as extravasation. However, in Japan, peripheral venous administration is common. This study aimed to clarify the current status of using CV ports in Japan and its associated patient and institutional factors in breast cancer cases. This retrospective cohort study used the Diagnosis Procedure Combination data documented between 2013 and 2022 from 238 hospitals. Participants were patients with breast cancer who underwent mastectomy and perioperative chemotherapy. Data on patient demographics, anticancer drugs used, and hospital characteristics were collected from the inpatient and outpatient episodes. Factors associated with CV port implantation were examined using logistic regression analysis. Among 45,960 patients, 113 (0.25%) underwent CV port implantation, mostly postoperatively and at trunk sites. Factors negatively associated with CV port use included partial mastectomy (Odds ratio, 0.62 [95% confidence interval,0.41–0.92]) (vs. total mastectomy), use of only irritant drugs (0.43[0.21–0.90]) (vs. vesicants), and treatment at medium-volume hospitals (0.34 [0.16–0.73]) (vs. low-volume hospitals), whereas use of both vesicant and irritant drugs or nonvesicant drugs, and high volume hospital did not show statistical significance. CV ports were used in only 0.25% of breast cancer surgery cases, suggesting highly selective utilization. Their implantation may be influenced not only by clinical factors but also by institutional characteristics and practice patterns, highlighting the need for the context-specific use of CV ports.