Can There be a Place for Intraoperative Salvaged Blood in Spine Tumor Surgery?
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Intraoperative cell salvage (IOCS) has been used in musculoskeletal surgery extensively. However, it has never found its place in musculoskeletal oncologic surgery. We have conducted the first-ever study to evaluate the feasibility of IOCS in combination with a leucocyte-depletion filter (LDF) in metastatic spine tumor surgery. This was to pave the path for use of IOCS-LDF in musculoskeletal oncologic surgery.
Patients with a known primary epithelial tumor, who were offered surgery for metastatic spinal disease, were recruited. Blood samples were collected at three different stages during the surgery: from the operative field before IOCS processing, after IOCS processing, and after IOCS-LDF processing. Three separate samples (5 mL each) were taken at each stage. Samples were examined using immunohistochemical monoclonal antibodies to identify tumor cells of epithelial origin.
Of 30 patients in the study, 6 were excluded for not fulfilling the inclusion criteria, leaving 24 patients. Malignant tumor cells were detected in the samples from the operative field before IOCS processing in eight patients and in the samples from the transfusion bag after IOCS processing in three patients. No viable malignant cell was detectable in any of the blood samples after passage through both IOCS and LDF.
The findings support the notion that the IOCS-LDF combination works effectively in eliminating tumor cells from salvaged blood, so this technique can be applied successfully in spine tumor surgery. This concept can then further be extended to whole musculoskeletal tumor surgery and other oncologic surgeries with further appropriate clinical studies.
KeywordsSpinal Metastasis Malignant Tumor Cell Oncologic Surgery Allogeneic Blood Transfusion Lung Cancer Surgery
The authors thank 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 YH and Dr Tony Setiobudi for contributing their cases to the study; Anaesthesia Unit (AU) Nurses at the NUHS Singapore for supporting the study by managing the IOCS machine & the LDF system. This research was supported by the National Medical Research Council, Singapore. We were awarded the grant in May 2011 to conduct a prospective study (grant NMRC/NIG/1055/2011; value of award: SGD 200,000.00; DSRB/IRB reference: 2011/00350).
Conflict of interest
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