The impact of intra-operative cell salvage during open radical prostatectomy

Abstract

BackgroundTo examine the effect of intra-operative cell salvage (ICS) in open radical prostatectomy.MethodsIn this retrospective cohort study, all patients undergoing open radical prostatectomy for malignancy at our institution between 10/04/2013 and 10/04/2017 were enrolled. Patients were grouped and compared based on whether they received ICS. Primary outcomes were allogeneic transfusion rates, and disease recurrence. Secondary outcomes were complications and transfusion-related cost.ResultsFifty-nine men were enrolled; 30 used no blood conservation technique, while 29 employed ICS. There were no significant differences between groups in age, pre- or post-operative haemoglobin, Charlson comorbidity index, operation duration or length of stay. Tumour characteristics were also similar between groups, including pre-operative prostate specific antigen, post-operative Gleason score, T-stage, nodal status and rates of margin positivity. Compared with controls, the ICS group had longer follow up (945 vs. 989 days; P=0.0016). The control and ICS groups were not significantly different in rates of tumour recurrence (6 vs. 3 patients; P=0.30) or complications (10 vs. 5 patients; P=0.16). While the proportion of patients receiving allogenic transfusion was similar (9 vs. 6 patients; P=0.41), fewer red blood products transfused (40 vs. 12 units) meant transfusion related costs were lower in ICS patients (AUD $47,666 vs. $37,429).ConclusionsICS reduced transfusion related costs, without affecting allogeneic transfusion rates, tumour recurrence or complication rates. These findings extend the literature supporting ICS in oncological surgery. Prospective randomised studies are needed to confirm the existing level III evidence.

Safety, efficacy and cost of intra-operative cell salvage during open radical prostatectomy

“…Indeed, existing meta-analysis of blood conservation strategies in oncological surgery have revealed higher rates of disease recurrence with allogeneic transfusion (8,9), but not ICS (13,14). Amongst all twelve comparative studies to date of ICS in radical prostatectomy, with study follow up ranging 0-64 months (median 36 months), groups receiving ICS have experienced similar or decreased rates of biochemical recurrence compared with controls (10,14).…”

“…This is consistent with similar works. While three prior studies of ICS in prostatectomy have reported significantly reduced ABT rates (35)(36)(37), most have not (10,(37)(38)(39)(40)(41)(42)(43)(44)(45). In our patients, we believe this is related to the high median pre-operative haemoglobin (152-154 g/L), low rates of transfusion in both groups (2-5%) and small sample size.…”

“…Australian process costs were first estimated in 2006 at AUD $370 per unit of allogeneic red blood cells infused (20). Several authors have subsequently applied the Australian Bureau of Statistics consumer price index for hospital and medical services to derive modern re-estimates of this cost, updated in 2010 to AUD $536 (10,11,21). We applied this same method to estimate a 59.1% increase from end-of-financial-year 2010 to 2019 (22).…”

“…Additionally, ABT has been shown to induce transfusion related immuno-modulation and increased cancer recurrence, including urological (8,9). The cost of administering a single unit of packed red blood cells (PRBC) also continues to rise, recently exceeding AUD $1,100 (10,11).…”

“…To d a t e , t h e l i t e r a t u r e o n I C S u s e i n r a d i c a l prostatectomy consists of twelve retrospective studies of median size 107 patients, with most published >15 years ago (10,14). Therefore, this study aims to undertake a large and contemporary assessment of patients undergoing open radical prostatectomy, examining the effect of ICS use on safety, efficacy and cost.…”