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- Title
Meta-analysis of primary open versus closed cannulation strategy for totally implantable venous access port implantation.
- Authors
Klaiber, Ulla; Probst, Pascal; Hackbusch, Matthes; Jensen, Katrin; Dörr-Harim, Colette; Hüttner, Felix J.; Hackert, Thilo; Diener, Markus K.; Büchler, Markus W.; Knebel, Phillip
- Abstract
Background: There is still no reference standard for the implantation of totally implantable venous access ports (TIVAPs). A recently published multicentre randomised controlled trial (RCT) revealed a significantly greater risk of pneumothorax after closed cannulation than after an open strategy. The aim of this meta-analysis was to provide an update of the available evidence for the safety and effectiveness of primary open versus closed cannulation strategy. Methods: RCTs comparing outcomes of open cut-down of the cephalic vein and closed cannulation of the subclavian vein were sought systematically in MEDLINE, Web of Science and CENTRAL. The primary outcome was the occurrence of pneumothorax. A beta-binominal model was applied to combine the respective outcomes, and results are presented as odds ratios (OR) with 95% confidence interval (CI). Results: Six RCTs with a total of 1831 patients were included in final analysis. Meta-analysis showed statistically significant superiority of the open cut-down technique regarding pneumothorax (OR 0.308, 95% CI 0.122 to 0.776), but a statistically significant higher failure of the primary technique for the open cut-down technique than for closed cannulation (OR 2.364, 95% CI 1.051 to 5.315). There were no significant differences between the two procedures regarding other morbidity endpoints. Conclusion: This meta-analysis shows a general superiority of open cut-down of the cephalic vein over closed cannulation of the subclavian vein regarding the occurrence of pneumothorax. Open cut-down should be the first-line approach for TIVAP implantation. Closed cannulation should be performed with ultrasound as second-line procedure if the open technique fails. Systematic review registration: PROSPERO CRD42013005180
- Subjects
CATHETERIZATION; SUBCLAVIAN veins; RANDOMIZED controlled trials
- Publication
Langenbeck's Archives of Surgery, 2021, Vol 406, Issue 3, p587
- ISSN
1435-2443
- Publication type
Article
- DOI
10.1007/s00423-020-02057-w