Department of General Surgery, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan.
Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, 7-115 Yatsuyamada, Koriyama, Fukushima, 963-8563, Japan.
Support Care Cancer. 2021 Sep;29(9):5391-5398. doi: 10.1007/s00520-021-06109-9. Epub 2021 Mar 10.
There is no concrete evidence to support the association between the amount of subcutaneous fat area (SFA) in the central venous port-insertion site (precordium) and port-related complications. We aimed to investigate the relationship between SFA in the midclavicular line and postoperative infectious complications in patients undergoing port-insertion surgery.
This was a single-institute and historical cohort study of 174 patients who underwent first central venous port implantation surgery for chemotherapy between January 2014 and December 2018. SFA in the midclavicular line was measured using preoperative computed tomography scans. The patients were divided into three groups according to SFA amount tertiles, and we investigated the association of SFA with infectious and all-cause complication events within 1 year.
Within a median follow-up of 306 days, the patients with intermediate SFA had significantly higher infection-free survival than those with low and high SFA (low vs. intermediate vs. high: 80.4% vs. 97.7% vs. 83.4%, respectively, p=0.034). In contrast, there was no significant difference in the overall complication-free survival among the groups (low vs. intermediate vs. high: 80.4% vs. 88.9% vs. 81.8%, respectively, p=0.29). Low SFA was independently associated with high risk of infectious complications (hazard ratio, 9.45; 95% confidence interval, 1.07-83.22, p=0.043).
Low SFA in the midclavicular line was an independent risk factor for infectious complications in the chemotherapy setting. This practical indicator can be useful for optimizing patients' nutritional status and when considering other types of vascular access to support administration of intravenous chemotherapy.
目前尚无具体证据支持中心静脉置管部位（前胸部）皮下脂肪面积（SFA）与置管相关并发症之间的关系。我们旨在研究锁骨中线 SFA 与接受置管手术患者术后感染性并发症之间的关系。
这是一项单中心、回顾性队列研究，纳入了 174 例于 2014 年 1 月至 2018 年 12 月期间因化疗而首次接受中心静脉置管的患者。使用术前计算机断层扫描（CT）测量锁骨中线 SFA。根据 SFA 量的三分位数将患者分为三组，研究 SFA 与 1 年内感染和全因并发症事件的关系。
中位随访 306 天内，中 SFA 组患者的无感染生存显著高于低 SFA 和高 SFA 组（低 SFA 组、中 SFA 组和高 SFA 组分别为 80.4%、97.7%和 83.4%，p=0.034）。相比之下，三组患者的总无并发症生存无显著差异（低 SFA 组、中 SFA 组和高 SFA 组分别为 80.4%、88.9%和 81.8%，p=0.29）。低 SFA 与感染性并发症的高风险独立相关（风险比，9.45；95%置信区间，1.07-83.22，p=0.043）。
锁骨中线 SFA 低是化疗患者感染性并发症的独立危险因素。这种实用指标可用于优化患者的营养状况，以及在考虑其他类型的血管通路以支持静脉化疗时使用。
