Are we ready for the use of intraoperative salvaged blood in metastatic spine tumour surgery?
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To evaluate the feasibility of using intraoperative cell salvage (IOCS) in combination with leucocyte depletion filter (LDF) in eliminating tumour cells from blood salvaged during metastatic spine tumour surgery (MSTS). This is with the view to pave the path for use of IOCS-LDF in MSTS and musculoskeletal oncological surgery.
Sixty consecutive patients with known primary epithelial tumour, who were offered surgery for metastatic spine disease at our university hospital, were recruited. Blood samples were collected at three different stages during surgery: from operative field prior to IOCS processing, after IOCS processing and after IOCS-LDF processing. Three separate samples (5 ml each) were taken at each stage. Samples were examined by cell block technique using immunohistochemical monoclonal antibodies to identify tumour cells of epithelial origin in the samples.
Of 60 patients, ten were excluded for not fulfilling the inclusion criteria leaving 50 patients. Malignant tumour cells were detected in the samples from operative field prior to IOCS processing in 24 patients and in the samples from the transfusion bag post-IOCS processing in 4 patients. No viable malignant cells were detectable in any of the blood samples after passage through both IOCS and LDF.
The findings support the notion that IOCS-LDF combination works effectively in eliminating tumour cells from salvaged blood so this technique can possibly be applied in MSTS and even musculoskeletal oncological surgery. This concept can then be extended to other oncological surgeries in general with further appropriate clinical studies.
KeywordsIntraoperative cell salvage Leucocyte depletion filter Metastatic spine tumour surgery Tumour cells Oncological surgery
The authors would like to thank the following: National Medical Research Council, Singapore for awarding the grant in November 2010 to conduct this prospective observational study. Grant number: NMRC/NIG/1055/2011, AOSpine East Asia Research Grant Project for awarding the grant in May 2014 to conduct the flow cytometry study for proving the concept. Grant number: AOSEA® 2014-01, Ms Aisha Dhewar and Ms Ee Yong Foo from the Department of Pathology for technical assistance in preparation of the cell blocks used in this study, A/Prof Gabriel Liu, A/Prof Joseph Thambiah, A/Prof Gamaliel Tan and Dr Tony Setiobudi for contributing their cases to the study.
Compliance with ethical standards
Conflict of interest
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