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Peer-reviewedCC BY 4.0Frontiers in Oncology

Nutritional anthropometric indicators predict achievable pocket depth in totally implantable venous access port implantation: a prospective study with 3D-printed measurement device

  • Min Hu1
  • Xiangrui Chen2
  • Xiaomei He2
  • Chengluo Hao2
  • Xiaobo Tong1
  • Yunwei Han3
  1. 1Department of Dermatology, Zigong Third People’s Hospital
  2. 2Department of Oncology, Zigong Third People’s Hospital
  3. 3Department of Oncology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University
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Abstract

Background: Pocket depth is a critical anatomical factor affecting complications after totally implantable venous access port (TIVAP) implantation. However, intraoperative depth assessment relies on empirical estimation without objective quantification. The relationship between preoperative nutritional status and achievable pocket depth remains unclear.

Methods: This prospective single-arm clinical trial enrolled 37 patients undergoing TIVAP implantation assisted by a novel 3D-printed pocket depth measurement device between September 2025 and February 2026. The primary endpoint was device-related adverse events (DRAEs) at 30-day follow-up. Secondary endpoints included the correlation between nutritional anthropometric indicators (max abdominal fat thickness by CT, waist circumference, BMI) and pocket depth.

Results: No device-related adverse events occurred (0%, 95% CI 0%-8.1%). Total complication rate was 2.7% (1/37). Max abdominal fat thickness demonstrated the strongest correlation with pocket depth ( r = 0.803, 95% CI 0.64-0.89, p < 0.001), explaining 64.4% of variance (R ² = 0.644). The prediction equation was: Pocket Depth (mm) = 2.50 + 0.103 × Max Abdominal Fat Thickness (mm). ROC analysis, following 1,000-iteration bootstrap internal validation, showed excellent predictive accuracy for deep pocket (≥5mm) with an optimism-corrected AUC of 0.942 (95% CI: 0.860-1.000) and an optimal cut-off of 14.5 mm (sensitivity 91.3%, specificity 85.7%). Notably, 21.6% of patients (8/37) had abdominal fat <10mm and achievable depth ≤3mm despite surgical goal of ≥5mm, indicating anatomical limitation imposed by subcutaneous tissue availability.

Conclusion: In the context of an early feasibility study, this research demonstrated the preliminary safety and feasibility of a 3D-printed pocket depth measurement device for TIVAP implantation. It pioneers the quantification of a strong correlation between nutritional indicators and pocket depth, enabling the proposal of exploratory risk stratification thresholds to identify patients with anatomical limitations theoretically associated with shallow pocket depth, and offering a novel nutritional perspective for subcutaneous device implantation.

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Cite

BibTeXRIS
BibTeX
@article{hu2026nutritional,
  title = {{Nutritional anthropometric indicators predict achievable pocket depth in totally implantable venous access port implantation: a prospective study with 3D-printed measurement device}},
  author = {Min Hu and Xiangrui Chen and Xiaomei He and Chengluo Hao and Xiaobo Tong and Yunwei Han},
  journal = {Frontiers in Oncology},
  year = {2026},
  month = oct,
  doi = {10.3389/fonc.2026.1898363},
  url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1898363/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Nutritional anthropometric indicators predict achievable pocket depth in totally implantable venous access port implantation: a prospective study with 3D-printed measurement device
AU  - Min Hu
AU  - Xiangrui Chen
AU  - Xiaomei He
AU  - Chengluo Hao
AU  - Xiaobo Tong
AU  - Yunwei Han
PY  - 2026
DA  - 2026/10/22
JO  - Frontiers in Oncology
DO  - 10.3389/fonc.2026.1898363
UR  - https://www.frontiersin.org/articles/10.3389/fonc.2026.1898363/full
AB  - Background: Pocket depth is a critical anatomical factor affecting complications after totally implantable venous access port (TIVAP) implantation. However, intraoperative depth assessment relies on empirical estimation without objective quantification. The relationship between preoperative nutritional status and achievable pocket depth remains unclear.  Methods: This prospective single-arm clinical trial enrolled 37 patients undergoing TIVAP implantation assisted by a novel 3D-printed pocket depth measurement device between September 2025 and February 2026. The primary endpoint was device-related adverse events (DRAEs) at 30-day follow-up. Secondary endpoints included the correlation between nutritional anthropometric indicators (max abdominal fat thickness by CT, waist circumference, BMI) and pocket depth.  Results: No device-related adverse events occurred (0%, 95% CI 0%-8.1%). Total complication rate was 2.7% (1/37). Max abdominal fat thickness demonstrated the strongest correlation with pocket depth ( r = 0.803, 95% CI 0.64-0.89, p < 0.001), explaining 64.4% of variance (R ² = 0.644). The prediction equation was: Pocket Depth (mm) = 2.50 + 0.103 × Max Abdominal Fat Thickness (mm). ROC analysis, following 1,000-iteration bootstrap internal validation, showed excellent predictive accuracy for deep pocket (≥5mm) with an optimism-corrected AUC of 0.942 (95% CI: 0.860-1.000) and an optimal cut-off of 14.5 mm (sensitivity 91.3%, specificity 85.7%). Notably, 21.6% of patients (8/37) had abdominal fat <10mm and achievable depth ≤3mm despite surgical goal of ≥5mm, indicating anatomical limitation imposed by subcutaneous tissue availability.  Conclusion: In the context of an early feasibility study, this research demonstrated the preliminary safety and feasibility of a 3D-printed pocket depth measurement device for TIVAP implantation. It pioneers the quantification of a strong correlation between nutritional indicators and pocket depth, enabling the proposal of exploratory risk stratification thresholds to identify patients with anatomical limitations theoretically associated with shallow pocket depth, and offering a novel nutritional perspective for subcutaneous device implantation.
SN  - 2234-943X
ER  -