Multicenter evaluation of anatomical landmark versus technology-assisted techniques for chemotherapy venous access...

The global incidence of cancer has significantly increased, resulting in the expanded use of innovative systemic treatments that require implantable vascular access devices, thus increasing the frequency of device implantation. These implants are associated with low complication rates, good patient tolerance, and a relatively short learning curve for both surgeons and radiologists. However, various factors, including patient characteristics, anatomical variations, underlying pathologies, and the surgeon's preferred technique, continue to pose challenges to standardized implementation. This variability may influence procedural success and complication rates. Therefore, a systematic comparison between anatomical landmark-based and technology-assisted approaches is necessary to determine whether differences in outcomes are attributable to the implantation method itself and to support evidence-based clinical decision-making. Hence, the importance of evaluating the outcomes of two common approaches to device implantation: one based on anatomical landmarks, relying solely on surface anatomical references for vascular access, and the other assisted by technology, which incorporates real-time imaging modalities such as ultrasound guidance for venous cannulation and fluoroscopic imaging for catheter tip positioning and procedural verification. This retrospective, multicenter cohort study analyzed oncology patients indicated for intravenous chemotherapy, with data collected from four institutions in Bogotá between June 1, 2016, and December 31, 2021. A total of 867 patients with diagnoses of hematolymphoid, gastric, colon, pancreatic, or breast cancer were included, excluding those with hypercoagulability syndrome, arrhythmias, or pacemaker use at the time of implantation. The data were systematically recorded using the REDCap^® application. Quantitative variables were analyzed using descriptive statistics, whereas categorical variables were analyzed using the chi-square test or Fisher's exact test, as appropriate. Continuous variables were assessed using t tests or Mann-Whitney U tests. Kaplan‒Meier survival models were used to analyze the time to complications based on the catheter insertion technique, and the anatomical reference point (ARP) technique was compared with the technology-assisted (TA) insertion technique. The incidence of complications was calculated using the relative risk (RR) with a significance level of p < 0.05. A total of 3,308 clinical records of patients undergoing totally implantable venous access device (TIVAD) implantation were reviewed, and 867 individuals who met the inclusion criteria were selected: 464 (53.5%) in the technology-assisted (TA) group and 403 (46.5%) in the anatomical reference point (ARP) group, with equivalent sociodemographic characteristics. The statistically significant findings included the presence of hematomas as a complication and the use of prophylactic antibiotics and fluoroscopy to assess catheter positioning, both of which are associated with a higher complication rate at 90 days post-operation. Additionally, a surgical time greater than or equal to 30 min was associated with a trend toward greater incidence of complications, although this difference did not reach statistical significance (RR = 4.24). No significant differences were found between implantation techniques based on anatomical reference points (ARPs) and those based on technology-assisted (TA) methods in terms of complication rates. The implantation of TIVADs in oncology patients with different primary cancers is safe and feasible. Although this study provides a clear definition of the advantages of different techniques, future research using controlled clinical trials is recommended to validate our findings and definitively determine the optimal TIVAD insertion technique.