Red‐cell salvage in urological surgery

Hamm, R; Daugherty, Mark O.; Crundwell, Malcolm

doi:10.1111/j.1464-410x.2004.04988.x

Cited by 5 publications

(1 citation statement)

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“…As mentioned above, ICS has been extensively investigated in radical prostate cancer surgery; in the largest study, which included over 1000 patients, cell salvage did not increase recurrence rates in the 25.5% of patients who received ICS (median follow‐up of 40.2 months) [21]. Similar results were found in other retrospective studies of urological cancers [13–15,18,22–24]. The present findings add to the body of evidence that long‐term follow‐up of patients undergoing cystectomy with cell salvage (without a leukocyte depletion filter) showed no apparent risk of reduced overall survival when compared with previously published series [25].…”

Section: Discussionsupporting

confidence: 84%

Towards bloodless cystectomy: a 10‐year experience of intra‐operative cell salvage during radical cystectomy

et al. 2012

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Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Guidance from the UK National Institute for Health and Clinical Excellence (NICE) on the use of intraoperative cell savage (ICS) has been in place for over 3 years and recommends its routine usage in all patients undergoing radical pelvic urological surgery. The current series describes the contribution of ICS to contemporary blood conservation strategies and the goal of ‘bloodless’ cystectomy. OBJECTIVE To describe a 10‐year experience of intra‐operative cell salvage (ICS) during radical cystectomy at a regional cancer centre. PATIENTS AND METHODS Between 1st January 2001 and 31st December 2010, 213 consecutive patients underwent radical cystectomy and pelvic lymphadenectomy for bladder cancer, with an ICS suction device used in theatre. Surgery was performed by one of three consultant surgeons using an open technique with lymph node clearance to the iliac bifurcation. Orthotopic bladder substitution was performed in 25% of patients overall. ICS data were collected prospectively on an electronic database and the institutional database was then cross‐referenced with a complete review of patients' medical records, laboratory results and radiological investigations retrospectively. Data collected included patient demographics, haemoglobin levels before and after surgery, the volume of ICS blood collected and re‐infused, complications related to ICS usage, the volume of allogeneic red blood cells (RBCs) transfused, length of stay and overall patient survival at 3 and 5 years after surgery. RESULTS In all 213 cases described, ICS was used without complication, with no recorded episodes of device failure and no complications related to the use of cell salvage. Overall, 91% of patients received ICS blood and 28% of patients avoided any further transfusion products. The median (range) follow‐up for the cohort was 24 (9–119) months. Seventy percent of the transfusion requirement for patients who underwent surgery in 2001 was met using allogeneic RBC transfusion but by 2010, as blood loss markedly reduced, ICS blood was able to provide ∼70% of overall transfusion requirements. As a consequence, the percentage of patients avoiding an allogeneic RBC transfusion significantly increased during the 10‐year period, such that 70% of patients avoided allogeneic RBC transfusion in 2010 compared with only 10–20% in the period 2001–2003 The overall survival rate at 3 and 5 years was 58% and 49%, respectively. CONCLUSIONS In conclusion, the use of ICS during radical cystectomy is safe; it is capable of meeting the majority of or, in some cases, the total blood product requirement for individual patients. As a result, it decreases the need for allogeneic RBC transfusion and hence the associated risks. Current follow‐up shows no apparent risk of decreased long‐term survival from an oncological perspective. The authors advocate routine availability of ICS for all major urological oncology cases.

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Section: Discussionsupporting

confidence: 84%

Towards bloodless cystectomy: a 10‐year experience of intra‐operative cell salvage during radical cystectomy

et al. 2012

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Terapia transfusional en cirugía oncológica

Vila¹,

Edo²,

Játiva³

et al. 2010

Tratado De Medicina Transfusional Perioperatoria

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Cell salvage as part of a blood conservation strategy in anaesthesia

Ashworth

Klein

2010

British Journal of Anaesthesia

240

174

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The use of intraoperative cell salvage and autologous blood transfusion has become an important method of blood conservation. The main aim of autologous transfusion is to reduce the need for allogeneic blood transfusion and its associated complications. Allogeneic blood transfusion has been associated with increased risk of tumour recurrence, postoperative infection, acute lung injury, perioperative myocardial infarction, postoperative low-output cardiac failure, and increased mortality. We have reviewed the current evidence for cell salvage in modern surgical practice and examined the controversial issues, such as the use of cell salvage in obstetrics, and in patients with malignancy, or intra-abdominal or systemic sepsis. Cell salvage has been demonstrated to be safe and effective at reducing allogeneic blood transfusion requirements in adult elective surgery, with stronger evidence in cardiac and orthopaedic surgery. Prolonged use of cell salvage with large-volume autotransfusion may be associated with dilution of clotting factors and thrombocytopenia, and regular laboratory or near-patient monitoring is required, along with appropriate blood product use. Cell salvage should be considered in all cases where significant blood loss (>1000 ml) is expected or possible, where patients refuse allogeneic blood products or they are anaemic. The use of cell salvage in combination with a leucocyte depletion filter appears to be safe in obstetrics and cases of malignancy; however, further trials are required before definitive guidance may be provided. The only absolute contraindication to the use of cell salvage and autologous blood transfusion is patient refusal.

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Red‐cell salvage in urological surgery

Cited by 5 publications

References 5 publications

Towards bloodless cystectomy: a 10‐year experience of intra‐operative cell salvage during radical cystectomy

Towards bloodless cystectomy: a 10‐year experience of intra‐operative cell salvage during radical cystectomy

Terapia transfusional en cirugía oncológica

Cell salvage as part of a blood conservation strategy in anaesthesia

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