Totally implanted ports and peripherally inserted central catheters for chemotherapy: a systematic review and meta-analysis of clinical outcomes and economic evaluations

Objectives: Chemotherapy, while effective, can damage blood vessels due to repeated punctures and drug irritants, leading to complications like tissue damage from infiltration, clots, and phlebitis. To reduce these risks and improve patient comfort, venous catheters such as centrally inserted access ports (PORTs) and peripherally inserted central catheters (PICCs) are commonly used. Methods: This study systematically reviewed and analyzed clinical and economic data comparing PORTs and PICCs in adult chemotherapy patients, considering randomized trials, observational studies, and cost-effectiveness analyses. Data on complications and costs were extracted, and meta-analyses were conducted. Risk of bias was also assessed. Results: Sixty-three studies were included. PORTs showed significantly lower rates (per 1000 catheter-days) of thrombosis, local infections, and catheter malposition compared to PICCs. Similar trends were seen for wound complications and mechanical issues. Economic analyses favored PORTs for cost-effectiveness. Study limitations included heterogeneity and potential bias, though overall quality was moderate to good. Conclusion: Findings support the clinical and economic value of PORTs for long-term chemotherapy, difficult venous access, and low-maintenance needs, whereas PICCs suit shorter treatment durations, patients unsuitable for minor surgery, or settings favoring bedside insertion. Decisions should align with the goals of the European Health Technology Assessment Regulation to harmonize medical device evaluation across Europe.