Alternative Technique For Implantable Venous Access Port Placement In Breast Cancer Patients Underwent Axillary Lymphadenectomy: An Intraoperative Axillary Vein Approach.

PURPOSE: The aim of this study was to develop a modified method to implant an implantable venous access port (IVAP) intraoperatively in patients with breast cancer. METHODS: Breast cancer patients requiring axillary lymphadenectomy and postoperative chemotherapy were enrolled into this study. In the procedure of axillary lymphadenectomy, the lateral thoracic vein or thoracoacromial vein which adjacent to the pectoralis minor muscle were identified. After removal of the axillary lymph nodes, the catheter was inserted through the vein branch and advanced into the subclavian vein as far as the superior vena cava. The distal end of the catheter was connected to the port. The port was placed over ipsilateral subclavicular fossa. RESULTS: From Octorber 2008 to Octorber 2010, 60 patients aged 23 to 72 years received the IVAP implantation using the intraoperative axillary vein approach. Of these patients, 55 underwent modified radical mastectomy and 55 underwent breast conservation surgery (lumpectomy plus axillary lymphadenectomy). IVAP placement was performed via the lateral thoracic vein in 28 cases, and through the thoracoacromial vein in 32 cases.There were no early postoperative complications associated with pneumothorax,hematoma.. Late postoperative complications occurred in four patients (4/60): one had infusion impeded; one developed catheter occlusion, one developed catheter disconnection, and one had a systemic infection and caused thrombosis. Three of these patients eventually required revision of the TIAP. CONCLUSION: The intraoperative axillary vein approach for IVAP implantation should be considered a safe and effective method for breast cancer patients underwent axillary lymphadenectomy.