Evaluation of implantable devices in medical oncology in Tunisia. Prospective study about 205 cases.

Objective: To evaluate the insertion and use of implantable central venous accesses in medical oncology at the Institute Salah Azaiz. Methods: From January 1992 to June 2000, 205 patients including 179 adults (118F/61M) and 26 children aged 7 months to 72 years (mean 37 years) requir ed the insertion of an implantable port (IP). Tumoral pathology was dominat ed by metastatic breast carcinoma (93/179), digestive cancer (42/179) and p aediatric cancer (26 cases). Results: Excluding 3 initial failures, we inserted 205 IP for 202 patients. The supraclavicular anatomic way (Yoffa) was used in 156/205 cases and the subclavicular (Aubaniac) for the resting 32 cases with a jugular conversio n in 17 cases. Initial complications were represented by 6 arterial punctur e (2.9 %), 3 pneumothorax (1.5 %) and 1 catheter migration in the right pul monary artery. Median life duration of the material was 210 days (3 to 1460 days) for adults and 185 days (3 to 1460 ays) for children. Mean life dura tion for the 205 IP was 240 days +/- 239 (3 to 1460 days) with a total of 4 9200 IF-days. We explanted 17 IP for infection (8 cases), cutaneous ulcerat ion (8 cases) and actinomycin extravasation (1 case). We observed 6 cases ( 2.9 %) of subclavian and jugular thrombosis treated by anticoagulants and c onservation management of the pori. Presently, 58 patients are alive with I P in place. Conclusion: Implantable ports represent a useful option in medical oncology for patients treated with prolonged chemotherapy and adjuvant treatments s uch as antibiotics, transfusion. This method allows a good comfort for the patients and also the treating team but requires a prealable training for t he nursing team. (C) 2001 Editions scientifiques et medicales Elsevier SAS.