Efficacy of Autotransfusion in Hepatectomy for Hepatocellular Carcinoma

Fujimoto, Jiro; Okamoto, Eizo; Yamanaka, Naoaki; Oriyama, Takeshi; Furukawa, Kazutaka; Kawamura, Eisuke; Tanaka, Tsuneo; Tomoda, Fumihito

doi:10.1001/archsurg.1993.01420210129021

Cited by 70 publications

(78 citation statements)

References 23 publications

(2 reference statements)

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“…Where filters are not used, most studies showed tumour cells passing through the cell saver [29,[33][34][35][36] though some types of cancer cells appeared to be removed by centrifugation, washing and a standard 40 micron filter [37]. In the 1990s there were several in-vitro clearance studies using early leucocyte depletion filters which claimed to show total removal of malignant cells [38][39][40][41][42][43][44][45][46].…”

Section: Discussionmentioning

confidence: 99%

“…All the in-vivo evidence has shown that cancer patients receiving cell salvaged blood do not get increased rates of recurrences or increased mortality, and there has been considerable clinical use of cell salvage in all types of cancer surgeryparticularly urology, over the last 20 years. Up to 2003 the evidence consisted of a small number of case reports and observational studies [51][52][53][54][55][56][57][58][59], and has been criticised as a result [50]. However, they do show no difference in recurrence rate with intra-operative cell salvage or a better outcome compared with allogeneic transfusion.…”

Section: Discussionmentioning

confidence: 99%

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Use of a leucocyte filter to remove tumour cells from intra‐operative cell salvage blood

Catling¹,

Williams²,

Freites³

et al. 2008

Anaesthesia

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SummaryThe intra-operative blood loss of 50 consecutive gynae-oncology patients undergoing surgery for endometrial, cervical or ovarian cancer was cell salvaged and filtered. In each case blood samples were taken from the effluent tumour vein, a central venous line, the cell saver reservoir, the cell salvage re-transfusion bag after processing but before filtration and from the cell salvage re-transfusion bag after processing and filtration. Samples were examined using immunohistochemical monoclonal antibody markers for epithelial cell lines. Viable, nucleated malignant cells were detected in 2 ⁄ 50 central venous samples, 34 ⁄ 50 reservoir samples and 31 ⁄ 50 unfiltered cell salvaged samples. After passage through a Pall RS leucocyte depletion filter no remaining viable, nucleated malignant cells were detected in any sample. The clinical risks of cell salvage in these circumstances should be reviewed in the light of the risks of allogeneic blood transfusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Use of a leucocyte filter to remove tumour cells from intra‐operative cell salvage blood

Catling¹,

Williams²,

Freites³

et al. 2008

Anaesthesia

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“…64 Malignancy recurrence or metastases secondary to perioperative transfusion practices is a difficult field of study given the heterogeneity of the clinical circumstance, the type and stage of cancer, and the long follow-up times required. Nonetheless, 15 clinical studies have been published reporting outcomes on patients who received transfusion of ICS blood intraoperatively during malignancy surgery [64][65][66][67][68][69][70][71][72][73][74][75][76][77][78] (Table 3). The majority of these studies were single-centre non-randomized small studies where the outcome of patients who received intraoperative ICS blood was compared with historic or case controls.…”

Section: Clinical Experiencementioning

confidence: 99%

“…Multiple surgical programs have continued to recognize both the potential benefit of autologous transfusion Cell salvage in oncologic surgery 1065 Table 3 Tumour recurrence in patients who received intraoperative autotransfusion of ICS blood during malignancy surgery-clinical studies and the potential harm of allogeneic transfusion, and they have persisted in offering ICS (± perioperative autologous donation) to their patients undergoing resection of malignancy. 66,69,70,72,74,76 This practice has afforded more than 20 years of experience from some of these teams who clearly have experienced benefit rather than detriment to their patients. The current body of in vitro evidence together with a growing clinical experience suggest that ICS should not be withheld from patients with malignancy.…”

Section: Evolution Of Practicementioning

confidence: 99%

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

Trudeau

Waters

Chipperfield

2012

Can J Anesth/J Can Anesth

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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

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“…Between 1986 and 1999, six studies (population size 20 to 54 patients) on patients operated for urogynecological cancer (n = 4) and hepatic cancer (n = 2) showed no change in the short-or medium-term survival, hence no metastatic dissemination. [11][12][13][14][15][16] All studies were performed as either a historic comparison or comparison with matched subjects. Randomized studies were not conducted.…”

Section: Patient Survival After Use Of the Cell Saver In Cancer Surgerymentioning

confidence: 99%

Use of the Cell Saver in Oncologic Surgery

Élias¹,

Billard

Lapierre

2001

Transfus Alt Transfus Med

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SUMMARY Use of the cell saver in oncologic surgery is controversial because of the risk of reinfusion of cancer cells remaining in the packed erythrocytes. Experimental and clinical studies have indeed confirmed the presence of residual cancer cells in packed red cells. However, six clinical studies with a limited number of patients showed no metastatic spread after processing of the blood with a cell saver. The adjunctive use of a leukocyte depletion filter (LDF) greatly reduces the number of cancerous cells in the pack whereas irradiation of the pack with 50 Gy destroys all the cancer cells. Strictly speaking, the stringent application of this safety principle would require use of a cell saver only in conjunction with an irradiator. Studies indicate that cancer cell seeding from infiltrative tumors seems to be greater than that observed when a cell saver is used. In the final analysis, we feel that it is reasonable to use the cell saver in oncologic surgery, if possible with a leukocyte filter, not only in cases of unexpected bleeding risk but also during scheduled procedures with a high risk of massive blood loss.

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Efficacy of Autotransfusion in Hepatectomy for Hepatocellular Carcinoma

Abstract: Autotransfusion is a safe and effective procedure in patients with hepatocellular carcinoma undergoing hepatectomy.

Cited by 70 publications

References 23 publications

Use of a leucocyte filter to remove tumour cells from intra‐operative cell salvage blood

Use of a leucocyte filter to remove tumour cells from intra‐operative cell salvage blood

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

Use of the Cell Saver in Oncologic Surgery

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