Ports and complications for intraperitoneal chemotherapy delivery

Abstract

Intraperitoneal access ports are essential to the delivery of chemotherapy agents into the peritoneal cavity of women with ovarian cancer, but their malfunction and adverse effects are frequently responsible for the failure to complete planned therapy. Complications, such as obstruction of the catheter, infection, leakage, rotation, retraction, and pain, together with bowel and vaginal perforation, cause delays in treatment, patient suffering and the expenditure of medical resources. A wide variety of ports have been used, including vascular access devices and intraperitoneal access devices. This paper reviews the development and use of ports for intraperitoneal chemotherapy, their complications and reported methods of prevention.

Cited rationale for variance in the use of primary intraperitoneal chemotherapy following optimal cytoreduction for stage III ovarian carcinoma at a high intraperitoneal chemotherapy utilization center

“…In the GOG-172 cohort, there was no difference in completion of 6 cycles of IV/IP chemotherapy when the IP port was inserted at the time of primary cytoreductive surgery versus as a separate subsequent procedure (26). An IP port should not be placed in a grossly contaminated field, but the initial concern over placing an IP port at the time of any bowel resection has subsided, as the rates of IP port infections do not appear to significantly differ when placed at a primary cytoreductive surgery in which an uncomplicated bowel resection is performed (27). The IP port infection rate in our cohort was 2%.…”

Feasibility and Safety of a Modified Outpatient Regimen With Intravenous/Intraperitoneal Chemotherapy for Optimally Debulked Stage III Ovarian Cancer

“…Of note, only 1 catheter-related complication causing treatment discontinuation has been registered, compared with other studies that have shown 15% of rate of IP treatment discontinuation, with obstruction (37.6%) and infection (31.4%) being the most common reasons. 26 Furthermore, we want to remark that 11 patients (52.4%) in our series underwent bowel resection to achieve optimal debulking, a known negative prognostic factor, classically associated with more port-related complications. However, because of the retrospective nature and small number of patients in our series, further studies are needed to establish the impact of large bowel resection and port-related toxicity.…”

Specific features of current intraperitoneal therapy in patients with ovarian cancer

“…Стандартными мезотелиальными марке-рами являются ICAM-1, цитокератины и Е-кадгерин. Хотя фибробласты и не признаны типичными клетка-ми брюшины, однако при нарушениях межклеточных соединений и потере апикально-базолатеральной по-лярности типичные клетки мезотелия превращаются в мигрирующие фибробластоподобные комплексы с повышенными инвазивными и фиброгенными свой-ствами, стимулирующие активный неоангиогенез [10]. Этот процесс, как первая линия обороны против пе-ритонеального карциноматоза, осуществляется за счет TGF-β и может быть активирован применением глю-козы, инфекцией или опухолью [11].…”