Intraoperative blood cells salvage in oncologic surgery.

Objectives: Intraoperative blood cells salvage using a Cell Saver technique is controversial in oncologic surgery because tumor cells could be aspirat ed and reinfused to the patient. The goal of this review was to discuss the risk associated with this technique, and the way to minimize it. Data sources: A review of the literature has been made by questioning PubMe d site (http://nbci.nlm.nih.gov) on the period of 1968 to 2000. The key wor ds were: intraoperative blood salvage, blood transfusion, autologous, cance r. Cases reports have been excluded. Study selection: Tumor cells aspirated and reinfused have been numbered in both experimental and clinical studies. In clinical studies, the outcome af ter intraoperative cells salvage/reinfusion has been compared to published data or historical groups of allogeneic transfusion, all in non randomized studies. Data synthesis: Both experimental and clinical studies confirmed the presen ce of cancer cells in the blood either aspirated or reinfused. However, six clinical studies with limited number of patients did not show metastatic s pread associated with Cell Saver. The addition of leukocyte filters reduces greatly this quantity of cancer cells. Irradiation of the pack did not des troy tumor cells but blocked their proliferative capacity. In the other han d, some infiltrative tumors were shown to have permanent cancer cells seedi ng, quantitatively superior to the seeding observed when a Cell Saver is us ed. Conclusion: It seems reasonable to use the Cell Saver in oncologic surgery, if possible with a leukocyte filter, not only in case of unexpected major bleeding (consensus), but also in programmed cases with high risk of huge h emorrhage. (C) 2000 Editions scientifiques et medicales Elsevier SAS.