TUMOR-CELLS IN BLOOD SHED FROM THE SURGICAL FIELD

Objectives: To analyze blood shed from the surgical field during oncol ogic surgery for tumor cells and to assess functional characteristics of these cells. Design and Patients: Series of 61 patients with cancer who underwent surgery for an abdominal, orthopedic, urological, gynec ological, or head and neck malignant tumor, and blinded comparison wit h 15 patients with benign diseases undergoing surgery. Setting: A 500- bed tumor center and a tertiary care hospital. Main Outcome Measures: Tumor cells were isolated from intraoperatively salvaged and washed bl ood by density gradient centrifugation. They were identified in cytosp in specimens by their content of cytokeratins and nucleolar organizer regions with a sensitivity of 10 cells in 500 mL of blood. Clonogenici ty was tested in a cell colony assay; invasiveness, in Boyden chambers ; and tumorigenicity, in nude mice. Results: In 57 of 61 patients, tum or cells were detected in the blood shed during oncologic surgery. The y demonstrated proliferation capacity, invasiveness, and tumorigenicit y. The total number of tumor cells identified ranged from 1X10(1) to 7 X10(6), with no close correlation to the amount of blood loss. Circula ting tumor cells were demonstrated in only 26% of these patients and i n small numbers. Conclusions: Malignant cells identified regularly in the blood shed during tumor surgery and different from circulating tum or cells are of concern, since at the surgical site they may cause loc al tumor recurrence, or in the salvaged blood they may cause hematogen ic metastasis after retransfusion. Therefore, the contraindication of intraoperative autotransfusion in tumor surgery is strongly supported, and a review of surgical procedures and adjuvant therapy may be indic ated, as the passage of the identified cells to the shed blood is yet unknown.