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Intraoperative cell salvage in metastatic spine tumour surgery reduces potential for reinfusion of viable cancer cells

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Abstract

Purpose

This study aimed at evaluating our hypothesis that tumour cells, which pass through the intraoperative cell salvage (IOCS) machine, lose viability due to possible injury to the cell membrane during centrifugation and filtration, enabling safe reinfusion even without filtration.

Methods

Thirteen patients who underwent metastatic spine tumour surgery (MSTS) at our institution were recruited. Blood samples (5 ml each) were collected at five different stages during surgery, namely, stage A and B: from patients’ vein during induction and at the time of maximum tumour manipulation; stage C, D and E: from the operative blood prior to IOCS processing, after IOCS processing and after IOCS-LDF (leucocyte depletion filter) processing, respectively. The samples were then analysed for viability of tumour cells using microwell-based culture.

Results

The median age of the patients was 65 years (range 37–77 years). The most common primary tumour was lung, followed by breast, hepatocellular and renal cell carcinoma. The median blood loss was 680 ml (range 300–1500 ml). Analysis of cultured blood samples showed that CTC-containing clusters were developed from some samples before IOCS-LDF processing (stage A: three patients, stage B: three patients and stage C: one patient). None of the samples from stages D and E generated clusters after culture, suggesting the absence of viable cancer cells after IOCS processing.

Conclusions

The salvaged blood may contain some tumour cells after processing with IOCS machine, but these cells are damaged and hence unable to replicate and unlikely to metastasise. The results of this study support the hypothesis that salvaged blood in MSTS is safe for transfusion.

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References

  1. Witham TF, Khavkin YA, Gallia GL, Wolinsky JP, Gokaslan ZL (2006) Surgery insight: current management of epidural spinal cord compression from metastatic spine disease. Nat Clin Pract Neurol 2:87–94. doi:10.1038/ncpneuro0116 (quiz 116)

    Article  PubMed  Google Scholar 

  2. Chen Y, Tai BC, Nayak D, Kumar N, Lim JW, Goy RWL, Wong HK (2013) Blood loss in spinal tumour surgery and surgery for metastatic spinal disease: a meta-analysis. Bone Joint J 95-B:683–688

    Article  CAS  PubMed  Google Scholar 

  3. Kawai A, Kadota H, Yamaguchi U, Morimoto Y, Ozaki T, Beppu Y (2005) Blood loss and transfusion associated with musculoskeletal tumor surgery. J Surg Oncol 92:52–58. doi:10.1002/jso.20375

    Article  PubMed  Google Scholar 

  4. Blajchman MA, Bordin JO (1995) The tumor growth-promoting effect of allogeneic blood transfusions. Immunol Invest 24:311–317

    Article  CAS  PubMed  Google Scholar 

  5. Blumberg N (1997) Allogeneic transfusion and infection: economic and clinical implications. Semin Hematol 34:34–40

    CAS  PubMed  Google Scholar 

  6. Kumar N, Ahmed Q, Lee VK, Chen Y, Zaw AS, Goy R, Agrawal RV, Dhewar AN, Wong HK (2014) Can there be a place for intraoperative salvaged blood in spine tumor surgery? Ann Surg Oncol 21:2436–2443. doi:10.1245/s10434-014-3569-x

    Article  PubMed  Google Scholar 

  7. Kumar N, Ahmed Q, Lee VK, Zaw AS, Goy R, Wong HK (2015) Are we ready for the use of intraoperative salvaged blood in metastatic spine tumour surgery? Eur Spine J. doi:10.1007/s00586-015-4112-x

    Google Scholar 

  8. Bower MR, Ellis SF, Scoggins CR, McMasters KM, Martin RC (2011) Phase II comparison study of intraoperative autotransfusion for major oncologic procedures. Ann Surg Oncol 18:166–173. doi:10.1245/s10434-010-1228-4

    Article  PubMed  Google Scholar 

  9. Catling S, Williams S, Freites O, Rees M, Davies C, Hopkins L (2008) Use of a leucocyte filter to remove tumour cells from intra-operative cell salvage blood. Anaesthesia 63:1332–1338. doi:10.1111/j.1365-2044.2008.05637.x (ANA5637 [pii])

    Article  CAS  PubMed  Google Scholar 

  10. Connor JP, Morris PC, Alagoz T, Anderson B, Bottles K, Buller RE (1995) Intraoperative autologous blood collection and autotransfusion in the surgical management of early cancers of the uterine cervix. Obstet Gynecol 86:373–378. doi:10.1016/0029-7844(95)00183-R

    Article  CAS  PubMed  Google Scholar 

  11. Ford BS, Sharma S, Rezaishiraz H, Huben RS, Mohler JL (2008) Effect of perioperative blood transfusion on prostate cancer recurrence. Urol Oncol 26:364–367. doi:10.1016/j.urolonc.2007.06.004

    Article  PubMed  Google Scholar 

  12. Kim JM, Kim GS, Joh JW, Suh KS, Park JB, Ko JS, Kwon CH, Yi NJ, Gwak MS, Lee KW, Kim SJ, Lee SK (2012) Long-term results for living donor liver transplant recipients with hepatocellular carcinoma using intraoperative blood salvage with leukocyte depletion filter. Transpl Int 26:84–89. doi:10.1111/tri.12001

    Article  PubMed  Google Scholar 

  13. Kumar N, Chen Y, Zaw AS, Nayak D, Ahmed Q, Soong R, Wong HK (2014) Use of intraoperative cell-salvage for autologous blood transfusions in metastatic spine tumour surgery: a systematic review. Lancet Oncol 15:e33–e41. doi:10.1016/S1470-2045(13)70245-6

    Article  PubMed  Google Scholar 

  14. Kumar N, Lam R, Zaw AS, Malhotra R, Tan J, Tan G, Setiobudi T (2014) Flow cytometric evaluation of the safety of intraoperative salvaged blood filtered with leucocyte depletion filter in spine tumour surgery. Ann Surg Oncol 21:4330–4335. doi:10.1245/s10434-014-3950-9

    Article  PubMed  Google Scholar 

  15. Martin RC, Wellhausen SR, Moehle DA, Martin AW, McMasters KM (2005) Evaluation of intraoperative autotransfusion filtration for hepatectomy and pancreatectomy. Ann Surg Oncol 12:1017–1024. doi:10.1245/ASO.2005.12.018

    Article  CAS  PubMed  Google Scholar 

  16. Perseghin P, Vigano M, Rocco G, Della Pona C, Buscemi A, Rizzi A (1997) Effectiveness of leukocyte filters in reducing tumor cell contamination after intraoperative blood salvage in lung cancer patients. Vox Sang 72:221–224

    Article  CAS  PubMed  Google Scholar 

  17. Khoo BL, Lee SC, Kumar P, Tan TZ, Warkiani ME, Ow SG, Nandi S, Lim CT, Thiery JP (2015) Short-term expansion of breast circulating cancer cells predicts response to anti-cancer therapy. Oncotarget 6:15578–15593

    Article  PubMed  PubMed Central  Google Scholar 

  18. Alix-Panabieres C, Pantel K (2013) Circulating tumor cells: liquid biopsy of cancer. Clin Chem 59:110–118. doi:10.1373/clinchem.2012.194258

    Article  CAS  PubMed  Google Scholar 

  19. Marrinucci D, Bethel K, Lazar D, Fisher J, Huynh E, Clark P, Bruce R, Nieva J, Kuhn P (2010) Cytomorphology of circulating colorectal tumor cells: a small case series. J Oncol 2010:861341. doi:10.1155/2010/861341

    Article  PubMed  PubMed Central  Google Scholar 

  20. Yu M, Bardia A, Wittner BS, Stott SL, Smas ME, Ting DT, Isakoff SJ, Ciciliano JC, Wells MN, Shah AM, Concannon KF, Donaldson MC, Sequist LV, Brachtel E, Sgroi D, Baselga J, Ramaswamy S, Toner M, Haber DA, Maheswaran S (2013) Circulating breast tumor cells exhibit dynamic changes in epithelial and mesenchymal composition. Science 339:580–584. doi:10.1126/science.1228522

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Lucci A, Hall CS, Lodhi AK, Bhattacharyya A, Anderson AE, Xiao L, Bedrosian I, Kuerer HM, Krishnamurthy S (2012) Circulating tumour cells in non-metastatic breast cancer: a prospective study. Lancet Oncol 13:688–695. doi:10.1016/S1470-2045(12)70209-7

    Article  PubMed  Google Scholar 

  22. Bidard FC, Mathiot C, Delaloge S, Brain E, Giachetti S, de Cremoux P, Marty M, Pierga JY (2010) Single circulating tumor cell detection and overall survival in nonmetastatic breast cancer. Ann Oncol: Off J Eur Soc Med Oncol/ESMO 21:729–733. doi:10.1093/annonc/mdp391

    Article  Google Scholar 

  23. Pierga JY, Bidard FC, Mathiot C, Brain E, Delaloge S, Giachetti S, de Cremoux P, Salmon R, Vincent-Salomon A, Marty M (2008) Circulating tumor cell detection predicts early metastatic relapse after neoadjuvant chemotherapy in large operable and locally advanced breast cancer in a phase II randomized trial. Clin Cancer Res: Off J Am Assoc Cancer Res 14:7004–7010. doi:10.1158/1078-0432.CCR-08-0030

    Article  CAS  Google Scholar 

  24. Poste G, Fidler IJ (1980) The pathogenesis of cancer metastasis. Nature 283:139–146

    Article  CAS  PubMed  Google Scholar 

  25. Paget S (1889) The distribution of secondary growths in cancer of the breast. Lancet 133:571–573

    Article  Google Scholar 

  26. Allan AL, Keeney M (2010) Circulating tumor cell analysis: technical and statistical considerations for application to the clinic. J Oncol 2010:426218. doi:10.1155/2010/426218

    Article  PubMed  Google Scholar 

  27. Chambers AF, Groom AC, MacDonald IC (2002) Dissemination and growth of cancer cells in metastatic sites. Nat Rev Cancer 2:563–572. doi:10.1038/nrc865

    Article  CAS  PubMed  Google Scholar 

  28. Chambers AF, Naumov GN, Varghese HJ, Nadkarni KV, MacDonald IC, Groom AC (2001) Critical steps in hematogenous metastasis: an overview. Surg Oncol Clin North Am 10:243–255 (vii)

    CAS  Google Scholar 

  29. Pantel K, Brakenhoff RH (2004) Dissecting the metastatic cascade. Nat Rev Cancer 4:448–456. doi:10.1038/nrc1370

    Article  CAS  PubMed  Google Scholar 

  30. Woodhouse EC, Chuaqui RF, Liotta LA (1997) General mechanisms of metastasis. Cancer 80:1529–1537

    Article  CAS  PubMed  Google Scholar 

  31. Karczewski DM, Lema MJ, Glaves D (1994) The efficiency of an autotransfusion system for tumor cell removal from blood salvaged during cancer surgery. Anesth Analg 78:1131–1135

    Article  CAS  PubMed  Google Scholar 

  32. Gorin MA, Eldefrawy A, Manoharan M, Soloway MS (2012) Oncologic outcomes following radical prostatectomy with intraoperative cell salvage. World J Urol 30:379–383. doi:10.1007/s00345-011-0746-4

    Article  PubMed  Google Scholar 

  33. Muscari F, Suc B, Vigouroux D, Duffas JP, Migueres I, Mathieu A, Lavayssiere L, Rostaing L, Fourtanier G (2005) Blood salvage autotransfusion during transplantation for hepatocarcinoma: does it increase the risk of neoplastic recurrence? Transpl Int 18:1236–1239. doi:10.1111/j.1432-2277.2005.00207.x

    Article  PubMed  Google Scholar 

  34. Nieder AM, Manoharan M, Yang Y, Soloway MS (2007) Intraoperative cell salvage during radical cystectomy does not affect long-term survival. Urology 69:881–884. doi:10.1016/j.urology.2007.01.060

    Article  PubMed  Google Scholar 

  35. Park SY, Choi GS, Park JS, Kim HJ, Ryuk JP, Choi WH (2012) Influence of surgical manipulation and surgical modality on the molecular detection of circulating tumor cells from colorectal cancer. J Korean Surg Soc 82:356–364. doi:10.4174/jkss.2012.82.6.356

    Article  PubMed  PubMed Central  Google Scholar 

  36. Liang J, Shen J, Chua S, Fan Y, Zhai J, Feng B, Cai S, Li Z, Xue X (2015) Does intraoperative cell salvage system effectively decrease the need for allogeneic transfusions in scoliotic patients undergoing posterior spinal fusion? A prospective randomized study. Eur Spine J 24:270–275. doi:10.1007/s00586-014-3282-2

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank AOSpine for granting AOSpine East Asia Research Award 2015 [AOSEA(R)2015-03]. 2. National University Health System for granting Bridging grant 2014 (NUHSRO/2014/013/Bridging/09) for conducting this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University Orthopaedics, Hand and Reconstructive Microsurgery, 1E, Kent Ridge Road, Singapore, 119228, Singapore

    Naresh Kumar, Aye Sandar Zaw & Gurpal Singh

  2. BioSystems and Micromechanics (BioSyM) Inter-Disciplinary Research Group, Singapore MIT Alliance for Research and Technology (SMART), National University of Singapore, Singapore, 138602, Singapore

    Bee Luan Khoo & Sayantani Nandi

  3. Department of Biomedical Engineering, National University of Singapore, 2 Engineering Drive 3, Singapore, 117581, Singapore

    Zhangxing Lai & Chwee Teck Lim

  4. Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore

    Jean Paul Thiery

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  1. Naresh Kumar
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Correspondence to Naresh Kumar.

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Kumar, N., Zaw, A.S., Khoo, B.L. et al. Intraoperative cell salvage in metastatic spine tumour surgery reduces potential for reinfusion of viable cancer cells. Eur Spine J 25, 4008–4015 (2016). https://doi.org/10.1007/s00586-016-4478-4

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  • DOI: https://doi.org/10.1007/s00586-016-4478-4

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