1
|
Altaweel W, Mehmood S, Seyam R. Intraoperative cell salvage transfusion in patients undergoing posterior urethroplasty: Its efficacy of reducing allogeneic blood transfusion, safety, and cost. Urol Ann 2022; 14:377-382. [PMID: 36505990 PMCID: PMC9731203 DOI: 10.4103/ua.ua_119_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/06/2022] [Indexed: 12/15/2022] Open
Abstract
Background A significant blood loss may be encountered with complex urethroplasty surgery. Blood management aims at reducing allogeneic blood transfusion (ABT) because of limited supply, associated risks, and cost. Intraoperative cell salvage (ICS) has been used in different urological and nonurological surgeries to achieve this goal. However, no study evaluated its role in perineal urethroplasty. Objectives We set out to determine the efficacy of reducing ABT, safety, and cost of ICS in posterior urethroplasty. Methods We reviewed the charts of all patients who underwent posterior urethroplasty between 2012 and 2017. We collected data for patients' demographics, pre- and postoperative hemoglobin level, ICS volume, complications, equivalent ABT units saved, and cost. Results Seventy patients with a median age of 27.5 ± 10.2 years underwent posterior urethroplasty. Of the 70 patients, 20 (28.57%) required ICS intraoperatively with a median of 441 ml/patient, equivalent to 1.47 units per patient of allogenic blood. No patient needed intraoperative ABT, whereas two patients required transfusions postoperatively. The median pre- and postoperative hemoglobin levels were 124.2 ± 9.2 and 110.3 ± 12.6 g/dl, respectively. There were no significant complications noted while using ICS. There was a 41% cost reduction of equivalent ABT units. Conclusions ICS is safe and effective in reducing ABT during posterior urethroplasty. In our hospital, it is associated with a significant cost reduction of blood transfusion.
Collapse
Affiliation(s)
- Waleed Altaweel
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shahbaz Mehmood
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Raouf Seyam
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
2
|
Frietsch T, Steinbicker AU, Horn A, Metz M, Dietrich G, Weigand MA, Waters JH, Fischer D. Safety of Intraoperative Cell Salvage in Cancer Surgery: An Updated Meta-Analysis of the Current Literature. Transfus Med Hemother 2022; 49:143-157. [PMID: 35813601 PMCID: PMC9210012 DOI: 10.1159/000524538] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/06/2022] [Indexed: 07/20/2023] Open
Abstract
Background Allogeneic blood transfusions in oncologic surgery are associated with increased recurrence and mortality. Adverse effects on outcome could be reduced or avoided by using intraoperative autologous blood cell salvage (IOCS). However, there are concerns regarding the safety of the autologous IOCS blood. Previous meta-analyses from 2012 and 2020 did not identify increased risk of cancer recurrence after using autologous IOCS blood. The objective of this review was to reassess a greater number of IOCS-treated patients to present an updated and more robust analysis of the current literature. Methods This systematic review includes full-text articles listed in PubMed, Cochrane, Cochrane Reviews, and Web of Science. We analyzed publications that discussed cell salvage or autotransfusion combined with the following outcomes: cancer recurrence, mortality, survival, allogeneic transfusion rate and requirements, length of hospital stay (LOS). To rate the strength of evidence, a Grading of Recommendations Assessment, Development and Evaluation (GRADE) of the underlying evidence was applied. Results In the updated meta-analysis, 7 further observational studies were added to the original 27 observational studies included in the former 2020 analysis. Studies compared either unfiltered (n = 2,311) or filtered (n = 850) IOCS (total n = 3,161) versus non-IOCS use (n = 5,342). Control patients were either treated with autologous predonated blood (n = 484), with allogeneic transfusion (n = 4,113), or did not receive a blood transfusion (n = 745). However, the current literature still contains only observational studies on these topics, and the strength of evidence remains low. The risk of cancer recurrence was reduced in recipients of autologous salvaged blood with or without LDF (odds ratio [OR] 0.76, 95% confidence interval [CI]: 0.64-0.90) compared to nontransfused patients or patients with allogeneic transfusion. There was no difference in mortality (OR 0.95, 95% CI: 0.71-1.27) and LOS (mean difference -0.07 days, 95% CI: -0.63 to 0.48) between patients treated with IOCS blood or those in whom IOCS was not used. Due to high heterogeneity, transfusion rates or volumes could not be analyzed. Conclusion Randomized controlled trials comparing mortality and cancer recurrence rate of IOCS with or without LDF filtration versus allogeneic blood transfusion were not found. Outcome was similar or better in patients receiving IOCS during cancer surgery compared to patients with allogeneic blood transfusion or nontransfused patients.
Collapse
Affiliation(s)
- Thomas Frietsch
- IAKH − German Interdisciplinary Task Force for Clinical Hemotherapy, Marburg, Germany
| | - Andrea U. Steinbicker
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Audrey Horn
- Department of Anesthesiology Perioperative and Pain Medicine, Stanford University, Stanford, California, USA
| | - Matthes Metz
- Department of Biostatistics, GCP-Service International Ltd. & Co. KG, Bremen, Germany
| | - Gerald Dietrich
- Department of Anesthesia, Intensive Care Medicine, Pain Therapy and Transfusion Medicine, Rottal-Inn-Kliniken, Eggenfelden, Germany
| | - Markus A. Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jonathan H. Waters
- Anesthesiology & Bioengineering, Patient Blood Management, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dania Fischer
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
3
|
Abstract
BACKGROUND Allogeneic blood transfusion is avoidable in many oncological interventions by the use of cell salvage or mechanical autotransfusion (MAT). As irradiation is elaborate and expensive, the safety of leucocyte depletion filters (LDF) for autologous blood from the surgical field might be a more acceptable alternative for the prevention of cancer recurrences. A previous meta-analysis could not identify an increased risk of cancer recurrence. The aim of this review article is to provide an update of a previous meta-analysis from 2012 as well as a safety analysis of cell salvage with LDF due to the improved data situation. MATERIAL AND METHODS This systematic review included all studies in PubMed, Cochrane, Cochrane Reviews and Web of Science on cell salvage or autotransfusion combined with outcomes, e.g. cancer recurrence, mortality, survival, blood transfusion, length of hospital stay (LOS) after the use of MAT without irradiation and with or without LDF. The grades of recommendations (GRADE) assessment of underlying evidence was applied. RESULTS A total of seven new observational studies and seven meta-analyses were found that compared unfiltered or filtered cell salvage with autologous predeposition, allogeneic transfusion or without any transfusion. No randomized controlled trials have been completed. A total of 27 observational and cohort studies were included in a meta-analysis. The evidence level was low. The risk of cancer recurrence in recipients of autologous salvaged blood with or without LDF was reduced (odds ratio, OR 0.71, 95% confidence interval, CI 0.58-0.86) as compared to non-transfused subjects, allogeneic or predeposited autologous transfusion. The transfusion rate could not be assessed due to the substantial selection bias and large heterogeneity. Cell salvage does not change mortality and LOS. Leucocyte depletion studies reported a removal rate of cancer cells in the range of 99.6-99.9%. CONCLUSION Randomized controlled trials on a comparison of MAT and allogeneic blood transfusion as well as LDF and irradiation would be desirable but are not available. From observational trials and more than 6300 subjects and various tumors, cell salvage in cancer surgery with or without LDF appears to be sufficiently safe. The efficacy of leucocyte depletion of autologous salvaged blood is equivalent to irradiation. Unavailability of radiation is not a contraindication for cell salvage use in cancer surgery. By usage of leucocyte depleted salvaged autologous blood, the risks of allogeneic transfusion can be avoided.
Collapse
|
4
|
Xu J, Kinnear N, Johns Putra L. Safety, efficacy and cost of intra-operative cell salvage during open radical prostatectomy. Transl Androl Urol 2021; 10:1241-1249. [PMID: 33850759 PMCID: PMC8039577 DOI: 10.21037/tau-20-1265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/27/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND We aim to examine the safety and efficacy of intra-operative cell salvage (ICS) in radical prostatectomy. METHODS A retrospective cohort study was performed, enrolling consecutive patients undergoing open radical prostatectomy at two institutions during 01/01/18-31/12/19. Patients were grouped by ICS use. Primary outcomes were allogeneic transfusion rates, and biochemical recurrence (prostate specific antigen >0.2 mg/mL). Secondary outcomes were use of adjuvant therapies, Clavien-Dindo complications and transfusion-related cost (allogeneic transfusion + ICS setup + ICS reinfusion). RESULTS In total, 168 men were enrolled. Patients were grouped based on whether they received no blood conservation technique (126 men) or ICS (42 men). Groups were similar in median age, pre- and post-operative haemoglobin and length of stay. They also had similar post-operative tumour Gleason score, TNM-stage and positive surgical margin rates. Compared with controls, the ICS group had shorter follow up (336 vs. 225 days; P=0.003). The groups had similar rates of biochemical recurrence (17% vs. 14%; P=0.90), adjuvant therapy use (30% vs. 29%; P=0.85) and complications (14% vs. 19% patients; P=0.46). There was no metastatic progression or cancer-specific mortality in either group. Although a similar proportion of patients received allogenic transfusion (2.4% vs. 4.8%; P=0.33) and units of packed red blood cells (PRBC) (9 vs. 5 units), transfusion-related costs were higher amongst the ICS group (AUD $11,422 vs. $43,227). CONCLUSIONS ICS use in radical prostatectomy was not associated with altered rates of allogeneic transfusion, complications, biochemical recurrence or adjuvant or salvage therapies. Transfusion related costs were higher in the ICS group.
Collapse
Affiliation(s)
- Jennifer Xu
- Department of Urology, Ballarat Base Hospital, Ballarat, Australia
| | - Ned Kinnear
- Department of Urology, Ballarat Base Hospital, Ballarat, Australia
- St John of God Hospital, Ballarat, Australia
| | - Lydia Johns Putra
- Department of Urology, Ballarat Base Hospital, Ballarat, Australia
- St John of God Hospital, Ballarat, Australia
| |
Collapse
|
5
|
Kinnear N, Hua L, Heijkoop B, Hennessey D, Spernat D. The impact of intra-operative cell salvage during open nephrectomy. Asian J Urol 2019; 6:346-352. [PMID: 31768320 PMCID: PMC6872782 DOI: 10.1016/j.ajur.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 02/23/2018] [Accepted: 04/13/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the impact of intra-operative cell salvage on outcomes in open nephrectomy. METHODS A retrospective cohort study was performed of all patients undergoing open nephrectomy for suspected malignancy from 1 October 2013 to 1 October 2017. Patients were grouped and compared based on whether they received intra-operative cell salvage (ICS). Primary outcomes were allogeneic transfusion rates (ATRs), and if histology confirmed cancer, disease recurrence. Secondary outcomes were complications and transfusion-related cost. RESULTS Forty patients underwent open nephrectomy for suspected malignancy during the enrolment period. Sixteen patients received ICS while 24 did not (standard group). Compared with the standard group, ICS patients had similar median age (63.5 vs. 61.0 years; p = 0.83) but fewer females (19% vs. 58%; p = 0.013). The groups were similar in pre-operative and discharge haemoglobin, Charlson Comorbidity Index, length of hospital stay and proportion with thoracoabdominal surgical approach. The ICS group had a smaller proportion undergoing partial nephrectomy (19% vs. 54%; p = 0.025) and shorter median follow-up (278 vs. 827 days; p = 0.0005). Histology was malignant for 14 ICS and 15 standard patients. The ICS group had more frequent ≥T2 disease (79% vs. 27%; p = 0.005). There were no positive margins. Both groups had similar ATRs (6% vs. 4%; p = 0.96), complication rates (19% vs. 29%; p = 0.46) and recurrence rates (18% vs. 7%; p = 0.40). Transfusion costs were higher amongst ICS patients (AUD $878.18 vs. $49.65 per patient). CONCLUSION ICS appears safe, with low rates of recurrence and complication. Both groups had low ATRs, and therefore cost benefit for ICS was not seen.
Collapse
Affiliation(s)
- Ned Kinnear
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Lina Hua
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Bridget Heijkoop
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Derek Hennessey
- Department of Urology, Craigavon Area Hospital, Portadown, UK
| | - Daniel Spernat
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| |
Collapse
|
6
|
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
|
7
|
Zacharias T, Ahlschwede E, Dufour N, Romain F, Theissen-Laval O. Intraoperative cell salvage with autologous transfusion in elective right or repeat hepatectomy: a propensity-score-matched case-control analysis. Can J Surg 2018; 61:105-113. [PMID: 29582746 DOI: 10.1503/cjs.010017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Liver resection may be associated with substantial blood loss, and cell saver use has been recommended for patients at high risk. We performed a study to compare the allogenic erythrocyte transfusion rate after liver resection between patients who had intraoperative cell salvage with a cell saver device versus patients who did not. Our hypothesis was that cell salvage with autologous transfusion would reduce the allogenic blood transfusion rate. METHODS Cell salvage was used selectively in patients at high risk for intraoperative blood loss based on preoperatively known predictors: right and repeat hepatectomy. Patients who underwent elective right or repeat hepatectomy between Nov. 9, 2007, and Jan. 27, 2016 were considered for the study. Data were retrieved from a liver resection database and were analyzed retrospectively. Patients with cell saver use (since January 2013) constituted the experimental group, and those without cell salvage (2007-2012), the control group. To reduce selection bias, we matched propensity scores. The primary outcome was the allogenic blood transfusion rate within 90 days postoperatively. Secondary outcomes were the number of transfused erythrocyte units, and rates of overall and infectious complications. RESULTS Ninety-six patients were included in the study, 41 in the cell saver group and 55 in the control group. Of the 96, 64 (67%) could be matched, 32 in either group. The 2 groups were balanced for demographic and clinical variables. The allogenic blood transfusion rate was 28% (95% confidence interval [CI] 12.5%-43.7%) in the cell saver group versus 72% (95% CI 56.3%-87.5%) in the control group (p < 0.001). The overall and infectious complication rates were not significantly different between the 2 groups. CONCLUSION Intraoperative cell salvage with autologous transfusion in elective right or repeat hepatectomy reduced the allogenic blood transfusion rate.
Collapse
Affiliation(s)
- Thomas Zacharias
- From the Service de chirurgie digestive, hépato-biliaire et endocrinienne, Pôle de Pathologies Digestives et Urologie (Zacharias); and the Pôle Anesthésie et Réanimation Chirurgicale, Hôpital Emile Muller, Mulhouse, France (Ahlschwede, Dufour, Romain, Theissen-Laval)
| | - Erich Ahlschwede
- From the Service de chirurgie digestive, hépato-biliaire et endocrinienne, Pôle de Pathologies Digestives et Urologie (Zacharias); and the Pôle Anesthésie et Réanimation Chirurgicale, Hôpital Emile Muller, Mulhouse, France (Ahlschwede, Dufour, Romain, Theissen-Laval)
| | - Nicole Dufour
- From the Service de chirurgie digestive, hépato-biliaire et endocrinienne, Pôle de Pathologies Digestives et Urologie (Zacharias); and the Pôle Anesthésie et Réanimation Chirurgicale, Hôpital Emile Muller, Mulhouse, France (Ahlschwede, Dufour, Romain, Theissen-Laval)
| | - Florence Romain
- From the Service de chirurgie digestive, hépato-biliaire et endocrinienne, Pôle de Pathologies Digestives et Urologie (Zacharias); and the Pôle Anesthésie et Réanimation Chirurgicale, Hôpital Emile Muller, Mulhouse, France (Ahlschwede, Dufour, Romain, Theissen-Laval)
| | - Odile Theissen-Laval
- From the Service de chirurgie digestive, hépato-biliaire et endocrinienne, Pôle de Pathologies Digestives et Urologie (Zacharias); and the Pôle Anesthésie et Réanimation Chirurgicale, Hôpital Emile Muller, Mulhouse, France (Ahlschwede, Dufour, Romain, Theissen-Laval)
| |
Collapse
|
8
|
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
|
9
|
Kinnear N, O'Callaghan M, Hennessey D, Liddell H, Newell B, Bolt J, Lawrentschuk N. Intra-operative cell salvage in urological surgery: a systematic review and meta-analysis of comparative studies. BJU Int 2018; 123:210-219. [PMID: 29726092 DOI: 10.1111/bju.14373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate systematically the safety and efficacy of intra-operative cell salvage (ICS) in urology. METHODS A search of Medline, Embase and Cochrane Library to August 2017 was performed using methods pre-published on PROSPERO. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Eligible titles were comparative studies published in English that used ICS in urology. Primary outcomes were allogeneic transfusion rates (ATRs) and tumour recurrence. Secondary outcomes were complications and cost. RESULTS Fourteen observational studies were identified, with a total of 4 536 patients. ICS was compared with no the blood conservation technique (seven studies), preoperative autologous donation (PAD; five studies) or both (two studies). Cohorts underwent open prostatectomy (11 studies), open cystectomy (two studies) or open partial nephrectomy (one study). Meta-analysis was possible only for ATRs within prostatectomy studies. In this setting, ICS reduced ATR compared with no the blood conservation technique (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.15-0.76) but not PAD (OR 0.76, 95% CI 0.39-1.31). In the non-prostatectomy setting, ATRs amongst patients who underwent ICS were significantly higher or similar in one and two studies, respectively. Tumour recurrence was found to be significantly less common (two studies), similar (eight studies) or not measured (four studies). All six studies reporting complications found no difference in their ICS cohorts. Regarding cost, one study from 1995 found ICS more expensive than PAD, while two more recent studies found ICS to be cheaper than no blood conservation technique. As a result of inter-study heterogeneity, meta-analyses were not possible for recurrence, complications or cost. CONCLUSION Low-level evidence exists that, compared with other blood conservation techniques, ICS reduces ATR and cost while not affecting complications. It does not appear to increase tumour recurrence post-prostatectomy, although follow-up durations were short. Small study sizes and short follow-ups mean conclusions cannot be drawn with regard to recurrence after nephrectomy or cystectomy. Randomized trials with long-term follow-up evaluating ICS in urology are required.
Collapse
Affiliation(s)
- Ned Kinnear
- Department of Urology, Austin Health, Melbourne, Vic., Australia.,Department of Urology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Michael O'Callaghan
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Flinders Medical Centre, Adelaide, SA, Australia.,School of Medicine, University of Adelaide, Adelaide, SA, Australia.,Flinders Centre for Innovation in Cancer, Adelaide, SA, Australia
| | - Derek Hennessey
- Department of Urology, Austin Health, Melbourne, Vic., Australia.,Department of Urology, Craigavon Area Hospital, Portadown, UK
| | - Heath Liddell
- Department of Urology, Austin Health, Melbourne, Vic., Australia.,Department of Urology, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Melbourne, Vic., Australia
| | - Bradley Newell
- Department of Urology, Austin Health, Melbourne, Vic., Australia
| | - John Bolt
- Department of Urology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Nathan Lawrentschuk
- Department of Urology, Austin Health, Melbourne, Vic., Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Vic., Australia
| |
Collapse
|
10
|
Kinnear N, Heijkoop B, Hua L, Hennessey DB, Spernat D. The impact of intra-operative cell salvage during open radical prostatectomy. Transl Androl Urol 2018; 7:S179-S187. [PMID: 29928615 PMCID: PMC5989116 DOI: 10.21037/tau.2018.04.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background To examine the effect of intra-operative cell salvage (ICS) in open radical prostatectomy. Methods In 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. Results Fifty-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). Conclusions ICS 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.
Collapse
Affiliation(s)
- Ned Kinnear
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Bridget Heijkoop
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Lina Hua
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | | | - Daniel Spernat
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| |
Collapse
|
11
|
The safety, efficacy, and cost-effectiveness of intraoperative cell salvage in metastatic spine tumor surgery. Spine J 2017; 17:977-982. [PMID: 28323241 DOI: 10.1016/j.spinee.2017.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 02/09/2017] [Accepted: 03/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND CONTEXT Metastatic spine tumor surgery (MSTS) is associated with substantial blood loss, therefore leading to high morbidity and mortality. Although intraoperative cell salvage with leukocyte depletion filter (IOCS-LDF) has been studied as an effective means of reducing blood loss in other surgical settings, including the spine, no study has yet analyzed the efficacy of reinfusion of salvaged blood in reducing the need for allogenic blood transfusion in patients who have had surgery for MSTS. PURPOSE This study aimed to analyze the efficacy, safety, and cost-effectiveness of using IOCS-LDF in MSTS. STUDY DESIGN This is a retrospective controlled study. PATIENT SAMPLE A total of 176 patients undergoing MSTS were included in the study. METHODS All patients undergoing MSTS at a single center between February 2010 and December 2014 were included in the study. The primary outcome measure was the use of autologous blood transfusion. Secondary outcome measures included hospital stay, survival time, complications, and procedural costs. The key predictor variable was whether IOCS-LDF was used during surgery. Logistic and linear regression analyses were conducted by controlling variables such as tumor type, number of diseased vertebrae, approach, number and site of stabilized segments, operation time, preoperative anemia, American Society of Anesthesiologists (ASA) grade, age, gender, and body mass index (BMI). No funding was obtained and there are no conflicts of interest to be declared. RESULTS Data included 63 cases (IOCS-LDF) and 113 controls (non-IOCS-LDF). Intraoperative cell salvage with LDF utilization was substantively and significantly associated with a lower likelihood of allogenic blood transfusion (OR=0.407, p=.03). Intraoperative cell salvage with LDF was cost neutral (p=.88). Average hospital stay was 3.76 days shorter among IOCS-LDF patients (p=.03). Patient survival and complication rates were comparable in both groups. CONCLUSIONS We have demonstrated that the use of IOCS-LDF in MSTS reduces the need for postoperative allogenic blood transfusion while maintaining satisfactory postoperative hemoglobin. We recommend routine use of IOCS-LDF in MSTS for its safety, efficacy, and potential cost benefit.
Collapse
|
12
|
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]
|
13
|
Ferroni MC, Correa AF, Lyon TD, Davies BJ, Ost MC. The use of intraoperative cell salvage in urologic oncology. Rev Urol 2017; 19:89-96. [PMID: 28959145 PMCID: PMC5610358 DOI: 10.3909/riu0721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intraoperative cell salvage (IOCS) has been used in urologic surgery for over 20 years to manage intraoperative blood loss and effectively minimize the need for allogenic blood transfusion. Concerns about viability of transfused erythrocytes and potential dissemination of malignant cells have been addressed in the urologic literature. We present a comprehensive review of the use of IOCS in urologic oncologic surgery. IOCS has been shown to preserve the integrity of erythrocytes during processing and effectively provides cell filtration to mitigate the risk of tumor dissemination. Its use is associated with reduction in the overall need for allogenic blood transfusion, which clinically reduces the risk of hypersensitivity reactions and disease transmission, and may have important implications on overall oncologic outcomes. In the context of a variety of urologic malignancies, including prostate, urothelial, and renal cancer, the use of IOCS appears to be safe, without risk of tumor spread leading to metastatic disease or differences in cancer-specific and overall survival. IOCS has been shown to be an effective intraoperative blood management strategy that appears safe for use in urologic oncology surgery. The ability to reduce the need for additional allogenic blood transfusion may have significant impact on immune-mediated oncologic outcomes.
Collapse
Affiliation(s)
- Matthew C Ferroni
- Department of Urology, University of Pittsburgh Medical CenterPittsburgh, PA
| | - Andres F Correa
- Department of Urology, University of Pittsburgh Medical CenterPittsburgh, PA
| | - Timothy D Lyon
- Department of Urology, University of Pittsburgh Medical CenterPittsburgh, PA
| | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical CenterPittsburgh, PA
| | - Michael C Ost
- Department of Urology, University of Pittsburgh Medical CenterPittsburgh, PA
| |
Collapse
|
14
|
Gaudino M, Lau C, Cammertoni F, Vargiu V, Gambardella I, Massetti M, Girardi LN. Surgical Treatment of Renal Cell Carcinoma With Cavoatrial Involvement: A Systematic Review of the Literature. Ann Thorac Surg 2016; 101:1213-21. [DOI: 10.1016/j.athoracsur.2015.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/08/2015] [Accepted: 10/01/2015] [Indexed: 01/17/2023]
|
15
|
Araujo RLC, Pantanali CA, Haddad L, Filho JAR, D’Albuquerque LAC, Andraus W. Does autologous blood transfusion during liver transplantation for hepatocellular carcinoma increase risk of recurrence? World J Gastrointest Surg 2016; 8:161-168. [PMID: 26981190 PMCID: PMC4770170 DOI: 10.4240/wjgs.v8.i2.161] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/10/2015] [Accepted: 12/02/2015] [Indexed: 02/07/2023] Open
Abstract
AIM: To analyze outcomes in patients who underwent liver transplantation (LT) for hepatocellular carcinoma (HCC) and received autologous intraoperative blood salvage (IBS).
METHODS: Consecutive HCC patients who underwent LT were studied retrospectively and analyzed according to the use of IBS or not. Demographic and surgical data were collected from a departmental prospective maintained database. Statistical analyses were performed using the Fisher’s exact test and the Wilcoxon rank sum test to examine covariate differences between patients who underwent IBS and those who did not. Univariate and multivariate Cox regression models were developed to evaluate recurrence and death, and survival probabilities were estimated using the Kaplan-Meier method and compared by the log-rank test.
RESULTS: Between 2002 and 2012, 158 consecutive patients who underwent LT in the same medical center and by the same surgical team were identified. Among these patients, 122 (77.2%) were in the IBS group and 36 (22.8%) in the non-IBS group. The overall survival (OS) and recurrence free survival (RFS) at 5 years were 59.7% and 83.3%, respectively. No differences in OS (P = 0.51) or RFS (P = 0.953) were detected between the IBS and non-IBS groups. On multivariate analysis for OS, degree of tumor differentiation remained as the only independent predictor. Regarding patients who received IBS, no differences were detected in OS or RFS (P = 0.055 and P = 0.512, respectively) according to the volume infused, even when outcomes at 90 d or longer were analyzed separately (P = 0.518 for both outcomes).
CONCLUSION: No differences in RFS or OS were detected according to IBS use. Trials addressing this question are justified and should be designed to detect small differences in long-term outcomes.
Collapse
|
16
|
Higgs VA, Rudloff E, Kirby R, Linklater AKJ. Autologous blood transfusion in dogs with thoracic or abdominal hemorrhage: 25 cases (2007-2012). J Vet Emerg Crit Care (San Antonio) 2015; 25:731-8. [PMID: 26193912 DOI: 10.1111/vec.12338] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 05/12/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the use and outcome following autologous blood transfusion (ABT) in dogs. DESIGN Retrospective study (January 2007-July 2012). SETTING Private veterinary referral center. ANIMALS Twenty-five dogs that underwent ABT secondary to thoracic or abdominal hemorrhage. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The hospital transaction database was searched using the keyword "autotransfusion" from January 2007 to July 2012. Data collected included signalment, body weight, etiology of hemorrhage, source and method of collection, volumes and method of ABT administration, use of anticoagulant, reported complications, and outcome. Twenty-five dogs were included for a total of 27 ABTs. Causes of hemorrhage included vascular trauma (14/25 dogs, 56%), ruptured tumor (8/25, 32%), and coagulopathy attributed to brodifacoum toxicosis (3/25, 12%). Autologous blood was collected from the abdominal (19/25, 76%), thoracic (5/25, 20%), or abdominal and thoracic cavities (1/25, 4%). Anticoagulant was added to the ABT blood in 13 of 25 (52%) cases. A median ABT volume of 29.3 mL/kg (range 2.9-406.9 mL/kg) was infused through either a 210 μm blood administration filter (21/27, 78%) or an 18 μm hemonate filter (6/27, 22%). Reported complications that may have been associated with ABT included hypocalcemia (4/17, 24%), hemolyzed serum (5/19, 26%), and prolonged coagulation times (4/5, 80%). These complications were considered of minimal clinical significance. Additional blood products were administered in 17 of 25 (68%) dogs. Seventeen (68%) dogs survived to discharge. Cause of death in the remaining cases was euthanasia or cardiac arrest secondary to uncontrollable hemorrhage. CONCLUSIONS ABT is an adjunct to volume replacement in dogs with thoracic or abdominal hemorrhage secondary to vascular trauma, ruptured tumor, or anticoagulant rodenticide toxicosis. ABT may be used as bridge to definitive hemorrhage control, particularly when other blood products are not available or affordable. Complications may include hypocalcemia, prolonged coagulation times, and hemolysis.
Collapse
|
17
|
Gong M, Yang JT, Liu YQ, Tang LH, Wang Y, Wang LJ, Zhang FJ, Yan M. Irradiation Can Selectively Kill Tumor Cells while Preserving Erythrocyte Viability in a Co-Culture System. PLoS One 2015; 10:e0127181. [PMID: 26018651 PMCID: PMC4446348 DOI: 10.1371/journal.pone.0127181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 04/13/2015] [Indexed: 12/16/2022] Open
Abstract
An understanding of how to safely apply intraoperative blood salvage (IBS) in cancer surgery has not yet been obtained. Here, we investigated the optimal dose of 137Cs gamma-ray irradiation for killing human hepatocarcinoma (HepG2), gastrocarcinoma (SGC7901), and colonic carcinoma (SW620) tumor cells while preserving co-cultured erythrocytes obtained from 14 healthy adult volunteers. HepG2, SGC7901, or SW620 cells were mixed into the aliquots of erythrocytes. After the mixed cells were treated with 137Cs gamma-ray irradiation (30, 50, and 100 Gy), tumor cells and erythrocytes were separated by density gradient centrifugation in Percoll with a density of 1.063 g/ml. The viability, clonogenicity, DNA synthesis, tumorigenicity, and apoptosis of the tumor cells were determined by MTT assay, plate colony formation, 5-ethynyl-2'-deoxyuridine (EdU) incorporation, subcutaneous xenograft implantation into immunocompromised mice, and annexin V/7-AAD staining, respectively. The ATP concentration, 2,3-DPG level, free Hb concentration, osmotic fragility, membrane phosphatidylserine externalization, blood gas variables, reactive oxygen species levels, and superoxide dismutase levels in erythrocytes were analyzed. We found that 137Cs gamma-ray irradiation at 50 Gy effectively inhibited the viability, proliferation, and tumorigenicity of HepG2, SGC7901, and SW620 cells without markedly damaging the oxygen-carrying ability or membrane integrity or increasing the oxidative stress of erythrocytes in vitro. These results demonstrated that 50 Gy irradiation in a standard 137Cs blood irradiator might be a safe and effective method of inactivating HepG2, SGC7901, and SW620 cells mixed with erythrocytes, which might help to safely allow IBS in cancer surgery.
Collapse
Affiliation(s)
- Ming Gong
- Department of Anesthesiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Jin-Ting Yang
- Department of Anesthesiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yun-Qing Liu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, Xuzhou 221004, China
| | - Li-Hui Tang
- Department of Anesthesiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yin Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, Xuzhou 221004, China
| | - Lie-Ju Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, Xuzhou 221004, China
| | - Feng-Jiang Zhang
- Department of Anesthesiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Min Yan
- Department of Anesthesiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
- * E-mail:
| |
Collapse
|
18
|
Use of intraoperative cell-salvage for autologous blood transfusions in metastatic spine tumour surgery: a systematic review. Lancet Oncol 2014; 15:e33-41. [DOI: 10.1016/s1470-2045(13)70245-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
19
|
Zhai B, Sun XY. Controversy over the use of intraoperative blood salvage autotransfusion during liver transplantation for hepatocellular carcinoma patients. World J Gastroenterol 2013; 19:3371-3374. [PMID: 23801828 PMCID: PMC3683674 DOI: 10.3748/wjg.v19.i22.3371] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 04/26/2013] [Accepted: 05/10/2013] [Indexed: 02/06/2023] Open
Abstract
Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. The critical points include whether tumor cells can be cleared by IBSA, whether IBSA increases the risk of recurrence or metastasis, and what are the indications for IBSA. Moreover, is it warranted to take the risk of tumor dissemination by using IBSA to avoid allogeneic blood transfusion? Do the remaining tumor cells after additional filtration by leukocyte depletion filters still possess potential tumorigenicity? Does IBSA always work well? We have reviewed the literature and tried to address these questions. The available data indicate that IBSA is safe in LT for HCC, but randomized, controlled and prospective trials are urgently required to clarify the uncertainty.
Collapse
|
20
|
Akbulut S, Kayaalp C, Yilmaz M, Ince V, Ozgor D, Karabulut K, Eris C, Toprak HI, Aydin C, Yilmaz S. Effect of autotransfusion system on tumor recurrence and survival in hepatocellular carcinoma patients. World J Gastroenterol 2013; 19:1625-1631. [PMID: 23538988 PMCID: PMC3602480 DOI: 10.3748/wjg.v19.i10.1625] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 01/12/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the therapeutic efficacy and safety of continuous autotransfusion system (CATS) during liver transplantation of hepatocellular carcinoma patients.
METHODS: Eighty-three hepatocellular carcinoma (HCC) patients who underwent liver transplantation with intraoperative CATS (n = 24, CATS group) and without (n = 59, non-CATS group) between April 2006 and November 2011 at the Liver Transplant Institute of Inonu University were analyzed retrospectively. Postoperative HCC recurrence was monitored by measuring alpha-fetoprotein (AFP) levels at 3-mo intervals and performing imaging analysis by thoracoabdominal multidetector computed tomography at 6-month intervals. Inter-group differences in recurrence and correlations between demographic, clinical, and pathological data were assessed by ANOVA and χ2 tests. Overall and disease-free survivals were calculated by the univariate Kaplan-Meier method.
RESULTS: Of the 83 liver transplanted HCC patients, 89.2% were male and the overall mean age was 51.3 ± 8.9 years (range: 18-69 years). The CATS and non-CATS groups showed no statistically significant differences in age, sex ratio, body mass index, underlying disease, donor type, graft-to-recipient weight ratio, Child-Pugh and Model for End-Stage Liver Disease scores, number of tumors, tumor size, AFP level, Milan and University of California San Francisco selection criteria, tumor differentiation, macrovascular invasion, median hospital stay, recurrence rate, recurrence site, or mortality rate. The mean follow-up time of the non-CATS group was 17.9 ± 12.8 mo, during which systemic metastasis and/or locoregional recurrence developed in 25.4% of the patients. The mean follow-up time for the CATS group was 25.8 ± 15.1 mo, during which systemic metastasis and/or locoregional recurrence was detected in 29.2% of the patients. There was no significant difference between the CATS and non-CATS groups in recurrence rate or site. Additionally, no significant differences existed between the groups in overall or disease-free survival.
CONCLUSION: CATS is a safe procedure and may decrease the risk of tumor recurrence in HCC patients.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Analysis of Variance
- Blood Transfusion, Autologous/adverse effects
- Blood Transfusion, Autologous/instrumentation
- Blood Transfusion, Autologous/mortality
- Carcinoma, Hepatocellular/blood
- Carcinoma, Hepatocellular/diagnostic imaging
- Carcinoma, Hepatocellular/mortality
- Carcinoma, Hepatocellular/secondary
- Carcinoma, Hepatocellular/surgery
- Chi-Square Distribution
- Equipment Design
- Female
- Humans
- Kaplan-Meier Estimate
- Liver Neoplasms/blood
- Liver Neoplasms/diagnostic imaging
- Liver Neoplasms/mortality
- Liver Neoplasms/pathology
- Liver Neoplasms/surgery
- Liver Transplantation/adverse effects
- Liver Transplantation/mortality
- Male
- Middle Aged
- Multidetector Computed Tomography
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/prevention & control
- Operative Blood Salvage/adverse effects
- Operative Blood Salvage/instrumentation
- Operative Blood Salvage/mortality
- Predictive Value of Tests
- Retrospective Studies
- Risk Factors
- Time Factors
- Treatment Outcome
- Turkey
- Young Adult
- alpha-Fetoproteins/metabolism
Collapse
|
21
|
Raval JS, Nelson JB, Woldemichael E, Triulzi DJ. Intraoperative cell salvage in radical prostatectomy does not appear to increase long-term biochemical recurrence, metastases, or mortality. Transfusion 2012; 52:2590-3. [PMID: 22612661 DOI: 10.1111/j.1537-2995.2012.03682.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Blood management strategies help to conserve allogeneic red blood cells, a finite resource. Intraoperative cell salvage (ICS) is an effective method of allogeneic avoidance. However, concerns persist about the safety of ICS in surgical oncology cases, including radical prostatectomy (RP). Previous findings do not support these concerns. We hypothesized that ICS would not increase rates of long-term prostate cancer recurrence characterized by biochemical failure, disease dissemination, or mortality. STUDY DESIGN AND METHODS Consecutive patients undergoing RP by a single urologist over two 3-month periods 1 year apart were analyzed retrospectively. Patients in the first period had preoperative autologous donation (PAD) but not ICS (PAD group), whereas those in the second period had ICS only (ICS group). Variables assessed included patient demographics, prostate-specific antigen levels at surgery and end of follow-up, clinical stage, operative time, surgical margin status, pathologic stage and grade, Gleason score sum, length of hospital stay, biochemical recurrence, metastases, and mortality. RESULTS A total of 116 consecutive patients were analyzed. Of these, 32 patients in the PAD group and 42 patients in the ICS group had follow-up of at least 4.75 years. There was a significantly higher rate of biochemical failure (34.4% vs. 9.5%; p = 0.02) and metastases (12.5% vs. 0%; p = 0.03) in the PAD group versus the ICS group; there was no significant difference in mortality (9.4% vs. 0%; p = 0.08). CONCLUSION ICS appears to be a safe and effective method of allogeneic blood conservation in patients undergoing RP. The findings suggest that there is no increased risk of biochemical failure, disease dissemination, or mortality at 5 years post-RP as a result of ICS use.
Collapse
Affiliation(s)
- Jay S Raval
- The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania 15213, USA.
| | | | | | | |
Collapse
|