Intraoperative cell salvage in metastatic spine tumour surgery reduces potential for reinfusion of viable cancer cells
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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.
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.
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.
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.
KeywordsMetastatic spine tumour surgery Intraoperative cell salvage Leucocyte depletion filter Circulating tumour cells (CTCs) Microwells
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.
Compliance with ethical standards
Conflict of interest
- 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 CrossRefPubMedGoogle 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 CrossRefPubMedPubMedCentralGoogle 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 CrossRefGoogle 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) 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 CrossRefPubMedGoogle 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 CrossRefPubMedGoogle Scholar