1
|
Goel N, Rhim AD, Xi H, Olive KP, Thomas AS, Kwon W, Schwartz J, Sugahara KN, Schrope BA, Chabot JA, Kluger MD. Transfusion of salvaged red blood cells during pancreatic ductal adenocarcinoma operations. Br J Surg 2023; 110:917-919. [PMID: 36461883 PMCID: PMC10361671 DOI: 10.1093/bjs/znac393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/26/2022] [Accepted: 10/24/2022] [Indexed: 07/20/2023]
Affiliation(s)
- Neha Goel
- Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Andrew D Rhim
- Department of Gastroenterology, Hepatology & Nutrition, MD Anderson Cancer Center, Houston, Texas, USA
| | - Huaqing Xi
- Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Kenneth P Olive
- Department of Medicine, Division of Digestive and Liver Diseases, and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Alexander S Thomas
- Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Wooil Kwon
- Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Joseph Schwartz
- Department of Anatomic Pathology and Clinical Pathology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kazuki N Sugahara
- Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Beth A Schrope
- Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - John A Chabot
- Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Michael D Kluger
- Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
2
|
Kumar N, Tan JYH, Chen Z, Ravikumar N, Milavec H, Tan JH. Intraoperative cell-salvaged autologous blood transfusion is safe in metastatic spine tumour surgery: early outcomes of prospective clinical study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2493-2502. [PMID: 37191676 DOI: 10.1007/s00586-023-07768-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Allogeneic blood transfusion (ABT) is current standard of blood replenishment despite known complications. Salvaged blood transfusion (SBT) addresses majority of such complications. Surgeons remain reluctant to employ SBT in metastatic spine tumour surgery (MSTS), despite ample laboratory evidence. This prompted us to conduct a prospective clinical study to ascertain safety of intraoperative cell salvage (IOCS), in MSTS. METHODS Our prospective study included 73 patients who underwent MSTS from 2014 to 2017. Demographics, tumour histology and burden, clinical findings, modified Tokuhashi score, operative and blood transfusion (BT) details were recorded. Patients were divided based on BT type: no blood transfusion (NBT) and SBT/ABT. Primary outcomes assessed were overall survival (OS), and tumour progression was evaluated using RECIST (v1.1) employing follow-up radiological investigations at 6, 12 and 24 months, classifying patients with non-progressive and progressive disease. RESULTS Seventy-three patients [39:34(M/F)] had mean age of 61 years. Overall median follow-up and survival were 26 and 12 months, respectively. All three groups were comparable for demographics and tumour characteristics. Overall median blood loss was 500 mL, and BT was 1000 mL. Twenty-six (35.6%) patients received SBT, 27 (37.0%) ABT and 20 (27.4%) NBT. Females had lower OS and higher risk of tumour progression. SBT had better OS and reduced risk of tumour progression than ABT group. Total blood loss was not associated with tumour progression. Infective complications other than SSI were significantly (p = 0.027) higher in ABT than NBT/SBT groups. CONCLUSIONS Patients of SBT had OS and tumour progression better than ABT/NBT groups. This is the first prospective study to report of SBT in comparison with control groups in MSTS.
Collapse
Affiliation(s)
- Naresh Kumar
- Department of Orthopaedic Surgery, Hand & Reconstructive Microsurgery Cluster, University Orthopaedics, National University Health System (NUHS) - Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Joel Yong Hao Tan
- Department of Orthopaedic Surgery, Hand & Reconstructive Microsurgery Cluster, University Orthopaedics, National University Health System (NUHS) - Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Zhaojin Chen
- Investigational Medicine Unit, Center for Translational Medicine, 14 Medical Drive, #07-01, Singapore, 117599, Singapore
| | - Nivetha Ravikumar
- Department of Orthopaedic Surgery, Hand & Reconstructive Microsurgery Cluster, University Orthopaedics, National University Health System (NUHS) - Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Helena Milavec
- Department of Orthopaedic Surgery, Hand & Reconstructive Microsurgery Cluster, University Orthopaedics, National University Health System (NUHS) - Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Jiong Hao Tan
- Department of Orthopaedic Surgery, Hand & Reconstructive Microsurgery Cluster, University Orthopaedics, National University Health System (NUHS) - Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119228, Singapore
| |
Collapse
|
3
|
Merolle L, Schiroli D, Farioli D, Razzoli A, Gavioli G, Iori M, Piccagli V, Lambertini D, Bassi MC, Baricchi R, Marraccini C. Reduction of EpCAM-Positive Cells from a Cell Salvage Product Is Achieved by Leucocyte Depletion Filters Alone. J Clin Med 2023; 12:4088. [PMID: 37373781 DOI: 10.3390/jcm12124088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Intraoperative cell salvage reduces the need for allogeneic blood transfusion in complex cancer surgery, but concerns about the possibility of it re-infusing cancer cells have hindered its application in oncology. We monitored the presence of cancer cells on patient-salvaged blood by means of flow cytometry; next, we simulated cell salvage, followed by leucodepletion and irradiation on blood contaminated with a known amount of EpCAM-expressing cancer cells, assessing also residual cancer cell proliferation as well as the quality of salvaged red blood cell concentrates (RBCs). We observed a significant reduction of EpCAM-positive cells in both cancer patients and contaminated blood, which was comparable to the negative control after leucodepletion. The washing, leucodepletion and leucodepletion plus irradiation steps of cell salvage were shown to preserve the quality of RBCs in terms of haemolysis, membrane integrity and osmotic resistance. Finally, cancer cells isolated from salvaged blood lose their ability to proliferate. Our results confirm that cell salvage does not concentrate proliferating cancer cells, and that leucodepletion allows for the reduction of residual nucleated cells, making irradiation unnecessary. Our study gathers pieces of evidence on the feasibility of this procedure in complex cancer surgery. Nevertheless, it highlights the necessity of finding a definitive consensus through prospective trials.
Collapse
Affiliation(s)
- Lucia Merolle
- Transfusion Medicine Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Davide Schiroli
- Transfusion Medicine Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Daniela Farioli
- Transfusion Medicine Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Agnese Razzoli
- Transfusion Medicine Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Gaia Gavioli
- Transfusion Medicine Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Mauro Iori
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Vando Piccagli
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Daniele Lambertini
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Maria Chiara Bassi
- Medical Library, Azienda USL-IRCCS di Reggio Emilia AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Roberto Baricchi
- Transfusion Medicine Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Chiara Marraccini
- Transfusion Medicine Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| |
Collapse
|
4
|
Zong YN, Xu CY, Gong YQ, Zhang XQ, Zeng H, Liu C, Zhang B, Xue LX, Guo XY, Wei F, Li Y. Effectiveness of intraoperative cell salvage combined with a modified leucocyte depletion filter in metastatic spine tumour surgery. BMC Anesthesiol 2022; 22:217. [PMID: 35820820 PMCID: PMC9277779 DOI: 10.1186/s12871-022-01743-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background To compare the effectiveness of intraoperative cell salvage (IOCS) combined with a modified leucocyte depletion filter (MLDF) with IOCS combined with a regular leucocyte depletion filter (RLDF) in eliminating tumour cells from blood salvage during metastatic spine tumour surgery (MSTS). Methods Patients with a known primary epithelial tumour who underwent MSTS were recruited for this study. Blood samples were collected in 5 stages: from the patients’ vein before anaesthesia induction (S1), from the operative field at the time of maximum tumour manipulation (S2), and from the operative blood after IOCS processing (S3) and after IOCS+RLDF (S4) and IOCS+MLDF (S5) processing. The polyploids of tumour cells in the blood samples were collected and counted with immunomagnetic separation enrichment and fluorescence in situ hybridization. Results We recruited 20 patients. Tumour cells were detected in 14 patients (70%) in S1, 16 patients (80%) in S2, 13 patients (65%) in S3, and 12 patients (60%) in S4. MLDF was added in 8 patients. Tumour cells were detected in only 1 of 8 patients in S5 (12.5%). There were significantly fewer tumour cells in the samples collected after MLDF processing (S5) than in the samples collected after RLDF (S4) and around the tumour (S2) (P = 0.016 and P = 0.039, respectively). Although no significant difference was observed between S4 and S1, a downward trend was observed after IOCS+RLDF processing. Conclusions Tumour cells could be removed by IOCS combined with RLDF from blood salvaged during MSTS, but residual tumour cells remained. The findings support the notion that MLDF eliminates tumour cells more effectively than RLDF. Hence, this technique can be applied to MSTS. Trial registration ChiCTR1800016162 Chinese Clinical Trial Registry.
Collapse
Affiliation(s)
- Ya-Nan Zong
- Department of Anesthesiology, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, People's Republic of China
| | - Chuan-Ya Xu
- Department of Anesthesiology, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, People's Republic of China
| | - Yue-Qing Gong
- Biobank, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, China
| | - Xiao-Qing Zhang
- Department of Anesthesiology, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, People's Republic of China
| | - Hong Zeng
- Department of Anesthesiology, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, People's Republic of China
| | - Chang Liu
- Department of Anesthesiology, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, People's Republic of China
| | - Bin Zhang
- Department of Anesthesiology, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, People's Republic of China
| | - Li-Xiang Xue
- Biobank, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, China
| | - Xiang-Yang Guo
- Department of Anesthesiology, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, People's Republic of China.
| | - Feng Wei
- Department of Orthopaedic, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, People's Republic of China.
| | - Yi Li
- Department of Anesthesiology, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, People's Republic of China.
| |
Collapse
|
5
|
Winter A, Zacharowski K, Meybohm P, Schnitzbauer A, Ruf P, Kellermann C, Lindhofer H. Removal of EpCAM-positive tumor cells from blood collected during major oncological surgery using the Catuvab device- a pilot study. BMC Anesthesiol 2021; 21:261. [PMID: 34715784 PMCID: PMC8555247 DOI: 10.1186/s12871-021-01479-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Intraoperative blood salvage (IBS) is regarded as an alternative to allogeneic blood transfusion excluding the risks associated with allogeneic blood. Currently, IBS is generally avoided in tumor surgeries due to concern for potential metastasis caused by residual tumor cells in the erythrocyte concentrate. METHODS The feasibility, efficacy and safety aspects of the new developed Catuvab procedure using the bispecific trifunctional antibody Catumaxomab was investigated in an ex-vivo pilot study in order to remove residual EpCAM positive tumor cells from the autologous erythrocyte concentrates (EC) from various cancer patients, generated by a IBS device. RESULTS Tumor cells in intraoperative blood were detected in 10 of 16 patient samples in the range of 69-2.6 × 105 but no residual malignant cells in the final erythrocyte concentrates after Catuvab procedure. IL-6 and IL-8 as pro-inflammatory cytokines released during surgery, were lowered in mean 28-fold and 52-fold during the Catuvab procedure, respectively, whereas Catumaxomab antibody was detected in 8 of 16 of the final EC products at a considerable decreased and uncritical residual amount (37 ng in mean). CONCLUSION The preliminary study results indicate efficacy and feasibility of the new medical device Catuvab allowing potentially the reinfusion of autologous erythrocyte concentrates (EC) produced by IBS device during oncological high blood loss surgery. An open-label, multicenter clinical study on the removal of EpCAM-positive tumor cells from blood collected during tumor surgery using the Catuvab device is initiated to validate these encouraging results.
Collapse
Affiliation(s)
- Andreas Winter
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
- Department of Anaesthesiology, University Hospital Wuerzburg, Oberdürrbacher Straße 6, 97080, Wuerzburg, Germany
| | - Andreas Schnitzbauer
- Department of General and Visceral Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Peter Ruf
- Trion Research GmbH, Am Klopferspitz 19, 82152, Martinsried, Germany
| | | | - Horst Lindhofer
- Trion Research GmbH, Am Klopferspitz 19, 82152, Martinsried, Germany
| |
Collapse
|
6
|
Perioperative Management of Patients for Whom Transfusion Is Not an Option. Anesthesiology 2021; 134:939-948. [PMID: 33857295 DOI: 10.1097/aln.0000000000003763] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
7
|
Warner MA, Shore-Lesserson L, Shander A, Patel SY, Perelman SI, Guinn NR. Perioperative Anemia. Anesth Analg 2020; 130:1364-1380. [DOI: 10.1213/ane.0000000000004727] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
8
|
Abstract
INTRODUCTION Autologous salvaged blood, commonly referred to as "cell saver" or "cell salvage" blood, is an important method of blood conservation. Understanding the mechanism of action and summarizing the existing evidence regarding the safety, efficiency, and the relative costs of cell salvage may help educate clinicians on how and when to best utilize autotransfusion. METHODS This review focuses on issues concerning the quality of red blood cells (RBC), efficiency, and the cost effectiveness relative to autotransfusion. The key considerations of safe use and clinical applicability are described along with the challenges for wider dissemination. RESULTS Cell salvage can reduce requirements for allogeneic transfusions, along with the associated risks and costs. Autologous salvaged RBCs provide high-quality transfusion, since the cells have not been subjected to the adverse effects of storage as occurs with banked blood. The risks for RBC alloimmunization and transfusion-related infectious diseases are also avoided. With a careful selection of cases, salvaged blood can be more cost effective than donor blood. Cell salvage may have a role in cardiac, major vascular, orthopedic, transplant, and trauma surgeries. However, there remain theoretical safety concerns in cases with bacterial contamination or in cancer surgery. CONCLUSION In addition to other methods of blood conservation used in patient blood management programs, autologous salvaged blood adds value and is cost effective for appropriate surgical cases. Evidence suggests that autologous salvaged blood may be of higher quality and confer a cost reduction compared with the allogeneic banked blood, when used appropriately.
Collapse
|
9
|
Kumar N, Tan JH, Ravikumar N, Tan JYH, Milavec H, Agrawal R, Kannan R, Kumar A. Evaluation of the Feasibility of Transfusing Leucocyte Depletion Filter (LDF) Processed Intra-Operative Cell Salvage (IOCS) Blood in Metastatic Spine Tumour Surgery (MSTS): Protocol for a Non Randomised study (Preprint). JMIR Res Protoc 2019. [DOI: 10.2196/16986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
10
|
Frank SM, Chaturvedi S, Goel R, Resar LMS. Approaches to Bloodless Surgery for Oncology Patients. Hematol Oncol Clin North Am 2019; 33:857-871. [PMID: 31466609 DOI: 10.1016/j.hoc.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Providing optimal care to surgical oncology patients who cannot be transfused for religious or other reasons can be challenging. However, with careful planning, using a combination of blood-conserving methods, these "bloodless" patients have clinical outcomes that are similar to other patients who can be transfused. Bloodless surgery can be accomplished safely for most patients, including those undergoing technically challenging oncologic surgery. This article reviews best practices used in a bloodless program during the preoperative, intraoperative, and postoperative periods, with the aim of achieving optimal outcomes when transfusion is not an option for surgical oncology patients.
Collapse
Affiliation(s)
- Steven M Frank
- Department of Anesthesiology/Critical Care Medicine, Center for Bloodless Medicine and Surgery, Johns Hopkins Health System Blood Management Clinical Community, The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medical Institutions, Zayed 6208, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Shruti Chaturvedi
- Division of Hematology, Department of Medicine, The Johns Hopkins Medical Institutions, Johns Hopkins Hospital, Ross Building Room 1032, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of Hematology/Oncology, Simmons Cancer Institute at SIU School of Medicine, 315 West Carpenter Street, Springfield, IL 62702, USA; Mississippi Valley Regional Blood Center
| | - Linda M S Resar
- Department of Medicine (Hematology), Oncology & Institute for Cellular Engineering, The Johns Hopkins Medical Institutions, Center for Bloodless Medicine and Surgery, Ross Building Room 1015, 1800 Orleans Street, Baltimore, MD 21287, USA
| |
Collapse
|
11
|
Wu WW, Zhang WY, Zhang WH, Yang L, Deng XQ, Ou MC, Yang YX, Liu HB, Zhu T. Survival analysis of intraoperative blood salvage for patients with malignancy disease: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e16040. [PMID: 31277097 PMCID: PMC6635293 DOI: 10.1097/md.0000000000016040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intraoperative blood salvage as a blood-saving strategy has been widely used in surgery. Considering its theoretic risk of malignant tumor cells being reinfused and the corresponding blood metastases, the safety of intraoperative blood salvage in cancer surgery remains controversial. METHODS Following the Preferred Reporting Items for Systemic Review and Meta-Analysis (PRISMA), we searched the Cochrane Library, MEDLINE and EMBASE to November 2017. We included only studies comparing intraoperative blood salvage with allogeneic blood transfusion. RESULTS This meta-analysis included 9 studies with 4354 patients with 1346 patients in the intraoperative blood salvage group and 3008 patients in the allogeneic blood transfusion group. There were no significant differences in the 5-year overall survival outcome (odds ratio [OR] 1.12; 95% confidence interval [CI], 0.80-1.58), 5-year disease-free survival outcome (OR 1.08; 95% CI 0.86-1.35), or 5-year recurrence rate (OR 0.86; 95% CI 0.71-1.05) between the 2 study groups. Subgroup analysis also showed no significant differences in the 5-year overall survival outcome (OR 0.97; 95% CI 0.57-1.67) of hepatocellular carcinoma patients in liver transplantation. CONCLUSIONS For patients with malignant disease, intraoperative blood salvage did not increase the tumor recurrence rate and had comparable survival outcomes with allogeneic blood transfusion.
Collapse
Affiliation(s)
- Wei-Wei Wu
- Department of Anesthesiology, West China Hospital
| | - Wei-Yi Zhang
- Department of Anesthesiology, West China Hospital
| | - Wei-Han Zhang
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Collaborative Innovation Center for Biotherapy, Sichuan University, Chengdu, Sichuan, China
| | - Lei Yang
- Department of Anesthesiology, West China Hospital
| | | | - Meng-Chan Ou
- Department of Anesthesiology, West China Hospital
| | - Yao-Xin Yang
- Department of Anesthesiology, West China Hospital
| | - Hai-Bei Liu
- Department of Anesthesiology, West China Hospital
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital
| |
Collapse
|
12
|
Kumar N, Ravikumar N, Tan JYH, Akbary K, Patel RS, Kannan R. Current Status of the Use of Salvaged Blood in Metastatic Spine Tumour Surgery. Neurospine 2018; 15:206-215. [PMID: 30071572 PMCID: PMC6226127 DOI: 10.14245/ns.1836140.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/13/2018] [Indexed: 12/15/2022] Open
Abstract
To review the current status of salvaged blood transfusion (SBT) in metastatic spine tumour surgery (MSTS), with regard to its safety and efficacy, contraindications, and adverse effects. We also aimed to establish that the safety and adverse event profile of SBT is comparable and at least equal to that of allogeneic blood transfusion. MEDLINE and Scopus were used to search for relevant articles, based on keywords such as "cancer surgery," "salvaged blood," and "circulating tumor cells." We found 159 articles, of which 55 were relevant; 20 of those were excluded because they used other blood conservation techniques in addition to cell salvage. Five articles were manually selected from reference lists. In total, 40 articles were reviewed. There is sufficient evidence of the clinical safety of using salvaged blood in oncological surgery. SBT decreases the risk of postoperative infections and tumour recurrence. However, there are some limitations regarding its clinical applications, as it cannot be employed in cases of sepsis. In this review, we established that earlier studies supported the use of salvaged blood from a cell saver in conjunction with a leukocyte depletion filter (LDF). Furthermore, we highlight the recent emergence of sufficient evidence supporting the use of intraoperative cell salvage without an LDF in MSTS.
Collapse
Affiliation(s)
- Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Nivetha Ravikumar
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Joel Yong Hao Tan
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Kutbuddin Akbary
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Ravish Shammi Patel
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Rajesh Kannan
- Department of Anaesthesiology, National University Hospital, Singapore
| |
Collapse
|
13
|
Zaw AS, Kantharajanna SB, Maharajan K, Tan B, Saparamadu AA, Kumar N. Metastatic spine tumor surgery: does perioperative blood transfusion influence postoperative complications? Transfusion 2017; 57:2790-2798. [DOI: 10.1111/trf.14311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/17/2017] [Accepted: 06/20/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Aye Sandar Zaw
- Department of Orthopaedic Surgery; National University Hospital; Singapore
| | | | | | - Barry Tan
- Department of Orthopaedic Surgery; National University Hospital; Singapore
| | | | - Naresh Kumar
- Department of Orthopaedic Surgery; National University Hospital; Singapore
| |
Collapse
|
14
|
Kumar N, Zaw AS, Kantharajanna SB, Khoo BL, Lim CT, Thiery JP. Metastatic efficiency of tumour cells can be impaired by intraoperative cell salvage process: truth or conjecture? Transfus Med 2017; 27 Suppl 5:327-334. [PMID: 28833768 DOI: 10.1111/tme.12453] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/17/2017] [Accepted: 07/21/2017] [Indexed: 01/16/2023]
Abstract
The use of salvaged blood in oncological surgery has been a matter of controversy over the years. This is due to the concern of systemic dissemination of reinfused tumour cells. Recent literature, across disciplines, has shed considerable light on its safety in terms of tumour recurrence, progression and overall survival rates. This clinical safety demonstrates the apparent metastatic inefficiency of reinfused tumour cells. The proof of this concept comes from various studies that have shown that salvaged blood has no tumour cells, or has a significantly lower count as compared to the patient's original circulatory tumour load. Recently, we took a step further and found that the tumour cells in the salvaged blood lose the capacity to replicate. In this review, we revisited the safety of salvaged blood from the point of view of metastatic potential. We have presented basic and applied science evidence regarding the innocuous nature of tumour cells that have been subjected to the cell salvage process. The understanding of the metastatic efficiency or the lack of it in tumour cells subjected to salvage process is key to allay the concerns conventionally associated with the use of salvaged blood in tumour surgery. Based on the available literature, we surmise that the prevalent apprehensions on the usage of salvaged blood are ill-founded and further substantiate why tumour cells in the salvaged blood could be regarded as cells with non-metastatic potential.
Collapse
Affiliation(s)
- N Kumar
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - A S Zaw
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - S B Kantharajanna
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - B L Khoo
- BioSystems and Micromechanics (BioSyM) Inter-Disciplinary Research Group, Singapore MIT Alliance for Research and Technology (SMART), National University of Singapore, Singapore, Singapore
| | - C T Lim
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - J P Thiery
- BioSystems and Micromechanics (BioSyM) Inter-Disciplinary Research Group, Singapore MIT Alliance for Research and Technology (SMART), National University of Singapore, Singapore, Singapore
| |
Collapse
|
15
|
Sikorski RA, Rizkalla NA, Yang WW, Frank SM. Autologous blood salvage in the era of patient blood management. Vox Sang 2017; 112:499-510. [DOI: 10.1111/vox.12527] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 04/01/2017] [Accepted: 04/06/2017] [Indexed: 12/11/2022]
Affiliation(s)
- R. A. Sikorski
- Department of Anesthesiology/Critical Care Medicine; The Johns Hopkins Medical Institutions; Baltimore MA USA
| | - N. A. Rizkalla
- Department of Anesthesiology/Critical Care Medicine; The Johns Hopkins Medical Institutions; Baltimore MA USA
| | - W. W. Yang
- Department of Anesthesiology/Critical Care Medicine; The Johns Hopkins Medical Institutions; Baltimore MA USA
| | - S. M. Frank
- Department of Anesthesiology/Critical Care Medicine; Johns Hopkins Health System Blood Management Program; The Johns Hopkins Medical Institutions; MA USA
| |
Collapse
|
16
|
Zaw AS, Bangalore Kantharajanna S, Kumar N. Is Autologous Salvaged Blood a Viable Option for Patient Blood Management in Oncologic Surgery? Transfus Med Rev 2017; 31:56-61. [DOI: 10.1016/j.tmrv.2016.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 06/03/2016] [Accepted: 06/16/2016] [Indexed: 02/07/2023]
|
17
|
Intraoperative cell salvage in metastatic spine tumour surgery reduces potential for reinfusion of viable cancer cells. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:4008-4015. [DOI: 10.1007/s00586-016-4478-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 01/27/2023]
|
18
|
Kumar N, Zaw AS, Khine HE, Maharajan K, Wai KL, Tan B, Mastura S, Goy R. Blood Loss and Transfusion Requirements in Metastatic Spinal Tumor Surgery: Evaluation of Influencing Factors. Ann Surg Oncol 2016; 23:2079-86. [DOI: 10.1245/s10434-016-5092-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Indexed: 11/18/2022]
|
19
|
Kumar N, Lam R, Zaw AS, Malhotra R, Tan J, Tan G, Setiobudi T. Flow cytometric evaluation of the safety of intraoperative salvaged blood filtered with leucocyte depletion filter in spine tumour surgery. Ann Surg Oncol 2014; 21:4330-5. [PMID: 25069862 DOI: 10.1245/s10434-014-3950-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Intraoperative cell salvage (IOCS) has not been widely adopted in oncological surgery due to the hypothetical concern of reinfusion of malignant cells. We evaluated the feasibility of IOCS in combination with leucocyte depletion filter (LDF) in metastatic spine tumour surgery (MSTS). METHODS Patients with known primary epithelial tumour, operated for metastatic spinal disease, were recruited. Blood samples were collected at five different stages during surgery: 2 stages from patient vein during induction and at the time of maximum tumour manipulation, 3 stages from the operative blood prior to IOCS processing, after IOCS processing, and after IOCS-LDF processing. Of the samples taken at each stage, 5 ml were analyzed for tumour cells using flow cytometry. RESULTS Of 12 patients recruited, only 11 could be finally analyzed. Flow cytometry analysis of their samples showed that 8 of 11 patients had tumour cells in the unfiltered salvaged blood. In filtered salvaged blood, the tumour cell count was zero in the majority of samples (8/11 patients), whereas three patients' samples had a few tumour cells. The mean difference between the tumour cell quantity in the samples from the patient vein and filtered salvaged blood was significant. CONCLUSIONS IOCS-LDF was shown to be effective in removing tumour cells from the blood salvaged during MSTS. If there were any tumour cells found, the quantity was significantly less than that in the patient's circulation. The results of this study reiterates the conclusions of our previous published work where we showed that IOCS-LDF treated blood in MSTS is safe for transfusion.
Collapse
Affiliation(s)
- Naresh Kumar
- Department of Orthopaedic Surgery, NUHS Tower Block, Level 11, National University Health System, Singapore, 119228, Singapore,
| | | | | | | | | | | | | |
Collapse
|