Evaluation of Intraoperative Autotransfusion Filtration for Hepatectomy and Pancreatectomy

Abstract

Intraoperative autotransfusion for major hepatectomy in metastatic colorectal cancer and pancreatectomy for adenocarcinoma is safe and should begin to be evaluated in a phase II study for efficacy.

Are we ready for the use of intraoperative salvaged blood in metastatic spine tumour surgery?

“…In that study, we proved that tumour cells in the filtered salvaged blood, if any, were significantly lower than amount of circulating tumour cells in the patients' blood. A similar study conducted by hepatobiliary oncologists [25] demonstrated the absence of any cytokeratin-positive carcinoma cells in filtered blood using flow cytometry technique. These surgical oncologists further investigated the safety and efficacy of intraoperative autotransfusion in patients undergoing major gastrointestinal oncologic procedures.…”

“…In gynae-oncology, Catling and colleagues [9], who studied the patients undergoing major surgery for endometrial, cervical and ovarian cancer, demonstrated that after passing salvaged blood through LDF, only tumour fragments which were not capable of causing metastasis could be found in the salvaged blood. Similarly, researchers in uro-oncology [21], thoracic-oncology [24] and hepatobiliary oncology [23,25] added the evidence by showing that passage of salvaged blood through IOCS-LDF could lead to no tumour cells in the post-LDF samples. Our findings were consistent with these findings by showing that IOCS-LDF processed blood was devoid of tumour cells.…”

“…They also concluded that salvaged blood was safe for reinfusion. They relied on the results of basic evidence studies conducted by Martin et al [25] and Laing et al [23]. Taking a lead from these studies, we feel that there is a strong case for conducting a clinical trial where salvaged blood can be transfused to patients undergoing MSTS.…”

Factors Influencing Perioperative Blood Transfusions in Patients with Gastrointestinal Cancer

“…Another promising approach utilizes cell scavenging and intraoperative hemodilution, as developed for a TF-free liver transplant program in Jehovah's witnesses: such technique was shown to effectively reduce TF of both red cells and plasma products in other transplant patients as well, despite higher patient acuity [47]. A preliminary study of flow cytometry on intraoperative autotransfusion material did not find circulating tumor cells, and would support such strategy for cancer patients as well [48].…”

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

“…These are ex vivo studies using oncologic cell lines that are seeded in banked or fresh blood 45,[51][52][53][54][55][56] or primary tumour cells collected at the time of tumour resection 48,49,[57][58][59] and then processed via ICS and subsequent LR filtration. Together, these studies show that advanced generation LR filters are very effective in the removal of tumour cells after ICS processing (the results of experiments where tumour cells were NOT completely removed are recorded in bold print in Table 1).…”