Should intraoperative cell-salvaged blood be used in patients with suspected or known malignancy?

Abstract

Should intraoperative cell-salvaged blood be used in patients with suspected or known malignancy? Les cellules sanguines épargnées en peropératoire doivent-elles être réutilisées chez des patients ayant des processus malins connus ou suspectés? Abstract Purpose Intraoperative cell salvage (ICS) is used as an alternative to allogeneic blood transfusion in an attempt to avoid or minimize the risks associated with allogeneic blood. Intraoperative cell salvage is generally avoided in surgeries where malignancy is confirmed or suspected due to concern for potential metastasis or cancer recurrence. The application of post-processing methods for ICS is hypothesized to eliminate this potential risk. The purpose of this narrative review is to examine the in vitro experimental evidence as it pertains to the removal of tumour cells from ICS blood and to review the clinical studies where ICS blood has been used in patients with malignancy. Source A search of the English literature for relevant articles published from 1973 to 2012 was undertaken using

Three-point transfusion risk score in hepatectomy

“…Intraoperative cell salvage has been avoided in malignant resections for fear of promoting metastasis. A recent meta‐analysis failed to show an association with cancer recurrence, and is corroborated by evidence that modern cell salvage devices filter malignant cells. Although there is increasing evidence that intraoperative cell salvage is safe in cancer surgery, it can be costly when used for patients who are unlikely to require a RBC transfusion, and preoperative identification of appropriate patients would be beneficial.…”

Management of severe perioperative bleeding

“…Leukodepletion filters appear to be an effective method for removal of malignant cells from ICS blood. 185 More recent non-randomised studies in urological cancer surgery and metastatic spinal surgery have shown ICS to decrease the need for allogeneic RBC transfusion with no apparent risk of decreased long-term survival from an oncological perspective. [186][187][188] Contamination of the surgical field (e.g.…”

Association of Anaesthetists guidelines: cell salvage for peri‐operative blood conservation 2018

“…The use of LDFs has not been shown to be associated with either bradykinin or leukotriene generation in cell‐salvaged blood . Cell salvage may reduce or eliminate exposure to allogeneic blood, which has been associated with immunosuppression and cancer recurrence . One major disadvantage of LDFs is that the rate of flow through them is considerably slower, and therefore clinicians may need to assess the benefit of quicker transfusion without a LDF vs. its use.…”