Complication-related removal of totally implantable venous access port systems: Does the interval between placement and first use and the neutropenia-inducing potential of chemotherapy regimens influence their incidence? A four-year prospective study of 4045 patients A. Kakkos a, * ,1 , L. Bresson a , D. Hudry a , S. Cousin b , C. Lervat c , E. Bogart d , J.P. Meurant d , S. El Bedoui a , G. Decanter a , K. Hannebicque a , C. Regis a , A. Hamdani e , N. Penel f , E. Tresch-Bruneel d , F. Narducci a a Department of Oncologic Surgery, Centre R egional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fr ederic Combemale, BP 307, 59020 Lille Cedex, France b Department of Medical Oncology, Centre R egional de Lutte Contre le Cancer Institut Bergoni e, 229 Cours de l’ Argonne, 33076 Bordeaux Cedex, France c Department of Pediatric Oncology, Centre R egional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fr ederic Combemale, BP 307, 59020 Lille Cedex, France d Department of Methodology and Biostatistics, Centre R egional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fr ederic Combemale, BP 307, 59020 Lille Cedex, France e Department of Anesthesiology and Reanimation, Centre R egional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fr ederic Combemale, BP 307, 59020 Lille Cedex, France f Department of Medical Oncology, Centre R egional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fr ederic Combemale, BP 307, 59020 Lille Cedex, France Accepted 21 October 2016 Available online 5 November 2016 Abstract Background: Totally implantable venous access port systems are widely used in oncology, with frequent complications that sometimes necessitate device removal. The aim of this study is to investigate the impact of the time interval between port placement and initiation of chemotherapy and the neutropenia-inducing potential of the chemotherapy administered upon complication-related port removal. Patients and methods: Between January 2010 and December 2013, 4045 consecutive patients were included in this observational, single- center prospective study. The chemotherapy regimens were classified as having a low (<10%), intermediate (10e20%), or high (>20%) risk for inducing neutropenia. Results: The overall removal rate due to complications was 7.2%. Among them, port-related infection (2.5%) and port expulsion (1%) were the most frequent. The interval between port insertion and its first use was shown to be a predictive factor for complication-related removal rates. A cut-off of 6 days was statistically significant ( p ¼ 0.008), as the removal rate for complications was 9.4% when this interval was 0e5 days and 5.7% when it was 6 days. Another factor associated with port complication rate was the neutropenia-inducing potential of the chemotherapy regimens used, with removal for complications involved in 5.5% of low-risk regimens versus 9.4% for the intermediate- and high-risk regimens ( p ¼ 0.003). * Corresponding author. Fax: þ33 3 20 29 59 28. E-mail address: athanasios.kakkos@gmail.com (A. Kakkos). 1 Permanent address: Department of Obstetrics and Gynecology, CHU de Li ege, site N. -D. des Bruy eres Rue Gaillarmont 600, 4032 Ch^ en ee, Belgium. Fax: þ32 4 367 95 14. http://dx.doi.org/10.1016/j.ejso.2016.10.020 0748-7983/Ó 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved. Available online at www.sciencedirect.com ScienceDirect EJSO 43 (2017) 689e695 www.ejso.com