{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:06:41Z","timestamp":1784696801453,"version":"3.55.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Emaciated oncology patients present unique challenges for totally implantable venous access port (TIVAP) implantation because of limited subcutaneous tissue coverage over the anterior chest wall. Conventional subcutaneous port placement in this population may increase the risk of local complications, including skin erosion, port exposure, and pocket infection. This study aimed to evaluate the feasibility, safety, and short-term clinical outcomes of supra-pectoralis major TIVAP implantation in emaciated oncology patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective single-center study included 188 consecutive emaciated oncology patients who underwent TIVAP implantation using the supra-pectoralis major technique at the Changshu Hospital Affiliated to Nanjing University of Chinese Medicine between January 2023 and June 2024. Emaciation was defined as a body mass index (BMI) &amp;lt;18.5 kg\/m\u00b2 and subcutaneous fat thickness \u22645 mm at the intended implantation site. All procedures were performed under ultrasound guidance, and catheter tip position was confirmed by fluoroscopy. Technical success, operative time, postoperative complications, and functional port retention during 6\u201312 months of follow-up were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 188 patients were included. The mean age was 70.2 \u00b1 7.8 years, and the mean BMI was 16.3 \u00b1 1.1 kg\/m\u00b2. Technical success was achieved in all patients (100%) with a mean operative time of 24.8 \u00b1 5.8 minutes. During follow-up, device-related complications occurred in 11 patients (5.85%), including port exposure in 2 (1.06%), pocket infection in 4 (2.13%), catheter malposition in 3 (1.60%), and fibrin sheath formation in 2 (1.06%). Four patients (2.13%) required port removal because of complications, while the remaining 184 patients (97.87%) retained a functional port until the end of follow-up or until death from underlying malignancy. During the observation period, 82 patients (43.62%) died from progression of the primary disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this single-center retrospective series, supra-pectoralis major implantation of TIVAPs was technically feasible in emaciated oncology patients and was associated with a high technical success rate and an acceptable short-term complication profile. These preliminary observations suggest that the technique may represent a practical implantation option in this vulnerable population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1836109","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:48:17Z","timestamp":1784695697000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Supra-pectoralis major implantation of totally implantable venous access ports in emaciated oncology patients: a single-center retrospective study"],"prefix":"10.3389","volume":"16","author":[{"given":"Dongdong","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Vascular Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine","place":["Changshu, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuxiang","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine","place":["Changshu, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine","place":["Changshu, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine","place":["Changshu, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingwei","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, The Second Affiliated Hospital of Soochow University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaming","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine","place":["Changshu, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00766-2","article-title":"Central venous access devices for the delivery of systemic anticancer therapy (CAVA): a randomised controlled trial","volume":"398","author":"Moss","year":"2021","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S142556","article-title":"Comparison of three types of central venous catheters in patients with Malignant tumor receiving chemotherapy","volume":"11","author":"Fang","year":"2017","journal-title":"Patient Pref Adherence"},{"key":"B3","doi-asserted-by":"publisher","first-page":"926","DOI":"10.12104\/j.issn.1674-4748.2022.07.016","article-title":"Research progress on nutritional risk assessment and influencing factors in cancer patients","volume":"20","author":"Fan","year":"2022","journal-title":"Chinese Gen Prac Nurs"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.advnut.2024.100282","article-title":"Prevalence of and survival with cachexia among patients with cancer: a systematic review and meta-analysis","volume":"15","author":"Watanabe","year":"2024","journal-title":"Adv Nutr"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2015.03.001","article-title":"Diagnostic criteria for malnutrition: an ESPEN consensus statement","volume":"34","author":"Cederholm","year":"2015","journal-title":"Clin Nutr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1002\/jcsm.13146","article-title":"Cachexia in patients with pancreatic cancer: prevalence, clinical significance, and management","volume":"14","author":"Hirth","year":"2023","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2024-080040","article-title":"Cancer cachexia","volume":"387","author":"Argil\u00e9s","year":"2024","journal-title":"BMJ"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2021.02.005","article-title":"ESPEN practical guideline: clinical nutrition in cancer","volume":"40","author":"Muscaritoli","year":"2021","journal-title":"Clin Nutr"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2023.107074","article-title":"Malnutrition in cancer patients: causes, consequences and treatment options","volume":"49","author":"Arends","year":"2023","journal-title":"Eur J Surg Oncol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.clnu.2016.07.015","article-title":"ESPEN guidelines on nutrition in cancer patients","volume":"36","author":"Arends","year":"2017","journal-title":"Clin Nutr"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007878.pub3","article-title":"Catheter impregnation, coating or bonding for reducing central venous catheter-related infections in adults","volume":"3","author":"Lai","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15194712","article-title":"Complications of central venous access devices used in palliative care settings for terminally ill cancer patients: a systematic review and meta-analysis","volume":"15","author":"Wong","year":"2023","journal-title":"Cancers (Bsl)"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-017-3816-3","article-title":"Totally implantable venous access ports: a prospective long-term study of early and late complications in adult patients with cancer","volume":"26","author":"Voog","year":"2018","journal-title":"Supp Care Cancer"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1024\/0301-1526\/a000802","article-title":"Power-injectable totally implantable venous access devices: analysis of success and complication rates of ultrasound-guided implantation and a patient satisfaction survey","volume":"50","author":"Kunz-Virk","year":"2021","journal-title":"Vasa"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3892\/mco.2016.726","article-title":"Totally implantable venous access port systems and associated complications: a single-institution retrospective analysis of 2,996 breast cancer patients","volume":"4","author":"Ma","year":"2016","journal-title":"Mol Clin Oncol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1177\/11297298251317296","article-title":"Comparison between arm port and chest port: a systematic review and meta-analysis","volume":"26","author":"Wei","year":"2025","journal-title":"J Vasc Access"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1177\/1178223418771909","article-title":"Upper-extremity deep vein thrombosis in patients with breast cancer with chest versus arm central venous port catheters","volume":"12","author":"Tippit","year":"2018","journal-title":"Breast Cancer (Auckl)"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.carj.2015.11.007","article-title":"Satisfaction and quality of life related to chemotherapy with an arm port: a pilot study","volume":"67","author":"Burbridge","year":"2016","journal-title":"Can Assoc Radiol J"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.12104\/j.issn.1674-4748.2020.28.017","article-title":"The application of chlorhexidine dressings in the prevention of local infection of implanted infusion ports","volume":"18","author":"He","year":"2020","journal-title":"Chin Gen Pract Nurs"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.33549\/physiolres.935045","article-title":"Acellular dermal matrix in plastic and reconstructive surgery","volume":"71","author":"Mihale\u010dko","year":"2022","journal-title":"Physiol Res"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000009338","article-title":"Acellular dermal matrix favorably modulates the healing response after surgery","volume":"150","author":"du Plessis","year":"2022","journal-title":"Plast Reconstr Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"699","DOI":"10.3969\/j.issn.1008-794X.2017.08.007","article-title":"Clinical application of right brachiocephalic vein approach for implanting venous access port","volume":"26","author":"Sun","year":"2017","journal-title":"J Interv Radiol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2007.09.005","article-title":"Cavoatrial junction and central venous anatomy: implications for central venous access tip position","volume":"19","author":"Baskin","year":"2008","journal-title":"J Vasc Interv Radiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1097\/NAN.0000000000000396","article-title":"Infusion therapy standards of practice, 8th edition","volume":"44","author":"Gorski","year":"2021","journal-title":"J Infus Nurs"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-020-05449-7","article-title":"Optimal prediction of the central venous catheter insertion depth targeting the cavoatrial junction","volume":"44","author":"Mo","year":"2020","journal-title":"World J Surg"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.11816\/cn.ni.2023-230332","article-title":"Expert consensus on maintenance and complication management of fully implanted infusion ports","volume":"33","author":"Zhang","year":"2023","journal-title":"Chin J Nosocomiol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3761\/j.issn.0254-1769.2022.05.005","article-title":"Evidence summary for the prevention and management of port-related venous thromboembolism in cancer patients","volume":"57","author":"Lu","year":"2022","journal-title":"Chin J Nurs"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn115682-20201119-06291","article-title":"Expert consensus on venous catheter maintenance","volume":"54","author":"Sun","year":"2019","journal-title":"Chin J Nurs"},{"key":"B29","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1200\/JCO.19.01461","article-title":"Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update","volume":"38","author":"Key","year":"2020","journal-title":"J Clin Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1836109\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:48:36Z","timestamp":1784695716000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1836109\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,22]]},"references-count":29,"alternative-id":["10.3389\/fonc.2026.1836109"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1836109","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,22]]},"article-number":"1836109"}}