Safety and feasibility of extending flushing interval every 3 months for maintenance of TICVPS in CRC patients after completion of curative intended treatments

Abstract

Abstract Background Colorectal cancer (CRC) patients treated with curative intended surgery undergo 5-FU continuous infusion based chemotherapy using totally implantable central venous port system (TICVPS) in case of high-risk of recurrence. Approximately 30% patients relapse after the completion of therapy, especially within 2 years. Hence, many of high-risk CRC patients keep the TICVPS during 6-24 months after treatment, with regular intervals of TICVPS flushing. The manufacturer recommends monthly flushing for maintain TICVPS, however the interval of flushing lacks scientific evidence. The aim of this study is to investigate whether the extended maintenance intervals is safe and feasible. Methods A retrospective cohort was conducted in CRC patients who underwent curative intended surgery and perioperative chemotherapy using TICVPS between 2010 and 2017. Patient were enrolled if TICVPS was maintained at least 6 months with 3-month interval flushing using heparin, while patient who were recurred within 1 month, removed TICVPS within 6 months without definitive causes, or violation of flushing interval were excluded. The primary end points were the functional TICVPS maintenance rate. Results A total of 214 CRC patients underwent curative intended treatments during the study period. Among them, 6 patients (early recurrence within 1 month) and 54 patients (violation of flushing interval) were excluded, finally 154 patients were analyzed. Mean flushing interval was 98.4 days. At the Dec 2018, 35 patients kept the TICVPS, 92 were planned removal, and 25 were reused the TICVPS, while two patients had to unexpectedly remove due to TICVPS site infection and pain. Thus, the functional TICVPS maintenance rate was 98.8%. 38 patients were relapsed and 30 were treated with intravenous chemotherapy. Among them, 25 patients (83.3%) were reused the existing TICVPS without re-insertion procedure. Conclusions Our study demonstrated that 3-month interval flushing is safe and feasible in CRC patients. Extended time interval up to 3 months might be considered because it is compatible with CRC surveillance visit schedules and convenient for patients. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.