Meta-analysis of primary open versus closed cannulation strategy for totally implantable venous access port implantation
Open Access
- 9 January 2021
- journal article
- review article
- Published by Springer Science and Business Media LLC in Langenbecks Archives Of Surgery
- Vol. 406 (3), 587-596
- https://doi.org/10.1007/s00423-020-02057-w
Abstract
Background There is still no reference standard for the implantation of totally implantable venous access ports (TIVAPs). A recently published multicentre randomised controlled trial (RCT) revealed a significantly greater risk of pneumothorax after closed cannulation than after an open strategy. The aim of this meta-analysis was to provide an update of the available evidence for the safety and effectiveness of primary open versus closed cannulation strategy. Methods RCTs comparing outcomes of open cut-down of the cephalic vein and closed cannulation of the subclavian vein were sought systematically in MEDLINE, Web of Science and CENTRAL. The primary outcome was the occurrence of pneumothorax. A beta-binominal model was applied to combine the respective outcomes, and results are presented as odds ratios (OR) with 95% confidence interval (CI). Results Six RCTs with a total of 1831 patients were included in final analysis. Meta-analysis showed statistically significant superiority of the open cut-down technique regarding pneumothorax (OR 0.308, 95% CI 0.122 to 0.776), but a statistically significant higher failure of the primary technique for the open cut-down technique than for closed cannulation (OR 2.364, 95% CI 1.051 to 5.315). There were no significant differences between the two procedures regarding other morbidity endpoints. Conclusion This meta-analysis shows a general superiority of open cut-down of the cephalic vein over closed cannulation of the subclavian vein regarding the occurrence of pneumothorax. Open cut-down should be the first-line approach for TIVAP implantation. Closed cannulation should be performed with ultrasound as second-line procedure if the open technique fails. Systematic review registration PROSPERO CRD42013005180Keywords
Funding Information
- Bundesministerium für Bildung und Forschung (01KG1217)
This publication has 40 references indexed in Scilit:
- Insertion of Totally Implantable Venous Access DevicesAnnals of Surgery, 2011
- Increased Use of Percutaneous Technique for Totally Implantable Venous Access Devices. Is It Real Progress? A 27-Year Comprehensive Review on Early ComplicationsAnnals of Surgical Oncology, 2010
- Effect of Immunoglobulin Therapy on the Rate of Infections in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation and or treated with immunomodulatory agentsMediterranean Journal of Hematology and Infectious Diseases, 2010
- Randomized clinical trial comparing venous cutdown with the Seldinger technique for placement of implantable venous access portsBritish Journal of Surgery, 2009
- Best choice of central venous insertion site for the prevention of catheter-related complications in adult patients who need cancer therapy: a randomized trialAnnals Of Oncology, 2009
- Randomized clinical trial of a modified Seldinger technique for open central venous cannulation for implantable access devicesBritish Journal of Surgery, 2009
- Reasons for Explantation of Totally Implantable Access Ports: A Multivariate Analysis of 385 Consecutive PatientsAnnals of Surgical Oncology, 2008
- Management of venous port systems in oncology: a review of current evidenceAnnals Of Oncology, 2007
- Implantation of central venous ports with catheter insertion via the right internal jugular vein in oncology patients—single center experienceSupportive Care in Cancer, 2006