INTRAOPERATIVE AUTOLOGOUS BLOOD COLLECTION AND AUTOTRANSFUSION IN THESURGICAL-MANAGEMENT OF EARLY CANCERS OF THE UTERINE CERVIX

Objectives: To evaluate intraoperative autologous blood collection wit h autotransfusion (Cell Saver) with respect to patient acceptance, ris k of tumor cell co-transfusion, and risk of recurrence in patients und ergoing radical hysterectomy for cervical cancer. Methods: All patient s explored for radical hysterectomy between August 1991 and July 1994 were offered the use of intraoperative autotransfusion. Clinical-patho logic and transfusion-related characteristics were compared for a grou p of historic controls surgically treated for similar disease. The ris k of tumor cell co-transfusion was assessed intraoperatively with peri toneal cytology before blood collection, and postoperatively with Cell Saver blood cytology. Results: Ninety-eight patients were offered enr ollment; four declined Cell Saver use, and 71 were acceptable for anal ysis. Thirty-one women (mean estimated blood loss 1338 mL) were reinfu sed with their own blood collected in the Cell Saver, whereas 40 patie nts (mean estimated blood loss 631 mL) were not autotransfused. There was no significant difference in preoperative hemoglobin concentration between groups. Cell Saver use significantly reduced the need for hom ologous transfusions, intraoperatively (P < .001) and postoperatively (P = .02). Historic controls (mean operative blood loss 1743 mL) were nearly four times more likely to have been transfused and three times more likely to have been transfused postoperatively than was the autot ransfused Cell Saver group. The mean hemoglobin concentration at disch arge was lower in the autotransfused group, 9.3 g/dL, than in the hist oric controls, 10.8 g/dL. Nontransfused Cell Saver blood and all perit oneal cytologies were negative for tumor cells. Three pelvic recurrenc es, but no disseminated disease, have been noted over a mean follow-up of 24 months: one in the autotransfused group and two in the group in which the collected blood was discarded. Conclusion: Cell Saver use i s well accepted by patients, decreases the need for homologous transfu sions, and does not appear to co-transfuse tumor cells.