Background: Totally implantable venous access port system (TIVAPS) is widely used in breast cancer therapy; TIVAPS has several associated complications depending on the depth of implantation in breast cancer (BC) patients during continuous infusional chemotherapy regimens. The purpose of this study is to find out the optimal depth of TIVAPS implantation to reduce the incidence of complications during infusional chemotherapy.

Methods: This study reviewed the depth of TIVAPS implantation in the internal jugular vein in 1282 breast cancer patients over a ten-year period (2009-2019), and associated complications. We segregated the patients as 5 groups: ‘Group A (depth < 4 mm), Group B (depth of 4-8 mm), Group C (depth of 8-12 mm), and Group D (depth of 12-16 mm), and Group E (depth of > 16 mm)’. Consequently, the ‘internal complications’ such as infection, venous thrombotic syndrome, catheter folding & migration, extravasation, whereas the ‘external complications’ viz., inflammation, local hematoma, local cutaneous reactions, and port exteriorization were significantly analyzed during TIVAPS implantation at different depths in BC patients.

Results: Overall incidence of ‘internal complications’ such as infections (8.6%, 2/23 cases), venous thrombotic syndrome (7.69%, 1/13 cases), catheter folding & migration (8.3%, 1/12 cases), and extravasation (8.3%, 1/12 cases) was comparatively lesser in Group C (8-12 mm) (p<0.01) than the Group A, Group B, Group D, and Group E respectively. Mainly, the external complications such as inflammation in Group C (8-12 mm) (pp< 0.01) was lesser (6.8%, 3/44 cases) than Group A, Group B, Group D, Group E. On the similar note, the local hematoma, and local cutaneous reaction, and port exteriorization were observed as ‘5% (1/20 cases), 4.2% (2/47 cases), and (3.2%, 1/31 cases)’ in Group C patients (p<0.01), which were comparatively lesser than the other groups.

Conclusion: Subcutaneous implantation of TIVAPS at a depth of 8-12 mm could be preferred due to the lowest incidence of internal and external complications compared to the incidence of these complications in other groups; this depth could be referred to as the safe and convenient implantation depth for the effective delivery of chemotherapy regimen in BC patients without difficulty in transcutaneous access to the port.

背景：完全植入式静脉通路系统（TIVAPS）广泛用于乳腺癌治疗；TIVAPS 有几种相关并发症，具体取决于乳腺癌 (BC) 患者在连续输注化疗方案期间的植入深度。本研究的目的是找出TIVAPS植入的最佳深度，以降低输注化疗期间并发症的发生率。

方法：本研究回顾了十年期间（2009-2019）1282 名乳腺癌患者颈内静脉 TIVAPS 植入的深度以及相关并发症。我们将患者分为 5 组：A 组（深度 < 4 mm）、B 组（深度 4-8 mm）、C 组（深度 8-12 mm）和 D 组（深度 12-16 mm ) 和 E 组（深度 > 16 毫米）'。因此，“内部并发症”如感染、静脉血栓形成综合征、导管折叠和迁移、外渗，而“外部并发症”即炎症、局部血肿、局部皮肤反应和端口外化在 TIVAPS 植入期间被显着分析BC 患者的不同深度。

结果：“内部并发症”的总体发生率，如感染（8.6%，2/23 例）、静脉血栓综合征（7.69%，1/13 例）、导管折叠和移位（8.3%，1/12 例）和C组（8-12 mm）的外渗（8.3%，1/12例）分别比A组、B组、D组和E组要少（p<0.01）。主要是C组（8-12 mm）炎症等外在并发症（pp<0.01）低于A组、B组、D组、E组（6.8%，3/44例）。 ，C组患者的局部血肿、局部皮肤反应和端口外化分别为“5%（1/20例）、4.2%（2/47例）和（3.2%，1/31例）” (p<0.01)，相对低于其他组。

结论： TIVAPS 皮下植入 8-12 mm 深度可能是首选，因为与其他组中这些并发症的发生率相比，内部和外部并发症的发生率最低；该深度可称为安全、方便的植入深度，可在 BC 患者中有效实施化疗方案，且不存在经皮进入端口的困难。