Abstract
BACKGROUND: Central venous access is essential for administering chemotherapy in patients with gastrointestinal cancer. Peripherally inserted central catheters (PICC) and totally implantable venous access ports (TIVAP) are widely used, but comparative data regarding their impact on catheter-related complications and quality of life (QoL) remain limited. AIM: To evaluate the impact of TIVAPs compared with PICC on catheter-related complications and QoL in patients with gastrointestinal cancer undergoing chemotherapy. METHODS: This retrospective study included adults with gastrointestinal cancer who underwent central venous access device insertion for chemotherapy at our institution between December 2021 and December 2024. Inclusion criteria encompassed indications for intermittent intravenous chemotherapy, anticipated treatment duration of ≥ 12 weeks, an adequate preoperative hematologic profile, accessible upper body veins, and complete medical records. Patients were excluded if they had an anticipated survival of less than three months, active systemic infection, severe thrombosis or coagulopathy, communication barriers, or an urgent need for dialysis access. Patients were assigned to either the PICC or TIVAP group based on device type. Data collected included demographic variables, cancer characteristics, insertion procedure details, complications, and QoL, assessed via the EuroQol 5-Dimensions-3 levels, visual analogue scale, and the European Organization for Research and Treatment of Cancer QoL Questionnaire-Core 30. RESULTS: A total of 346 patients were analyzed. Baseline demographic, clinical, and cancer characteristics were similar between groups. The TIVAP group demonstrated a significantly lower incidence of catheter-related complications than the PICC group, with no pneumothorax occurring in either group. QoL assessments at baseline were comparable. At one month, the TIVAP group exhibited significantly higher EuroQoL Five Dimensions health state scores and QLQ-C30 global health status scores. Multivariate analysis identified TIVAP use, catheter tip placement in the distal superior vena cava/right atrium, prophylactic antibiotic administration, and antimicrobial dressing application as independent protective factors associated with reduced complications and improved QoL. CONCLUSION: In patients with gastrointestinal cancer undergoing chemotherapy, TIVAPs are associated with a lower incidence of catheter-related complications and improved QoL than PICCs. Optimal device selection, precise catheter tip positioning, and effective perioperative management are critical for minimizing complications and enhancing patient-reported outcomes during treatment.