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Can There be a Place for Intraoperative Salvaged Blood in Spine Tumor Surgery?

  • Neuro-Oncology
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgment

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).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore

    Naresh Kumar FRCS, Yongsheng Chen MRCS, Aye Sandar Zaw MPH & Hee Kit Wong MChOrth

  2. Departments of Pathology, National University Hospital, Singapore, Singapore

    Qasim Ahmed Diplomate ABPath, Victor K. M. Lee FRCPA & Aisha Naheed Dhewar MSc

  3. Departments of Anaesthesia, National University Hospital, Singapore, Singapore

    Raymond Goy FANZCA & Rohit Vijay Agrawal FANZCA

Authors
  1. Naresh Kumar FRCS
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  2. Qasim Ahmed Diplomate ABPath
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  8. Aisha Naheed Dhewar MSc
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  9. Hee Kit Wong MChOrth
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Corresponding author

Correspondence to Naresh Kumar FRCS.

Additional information

Conference presentation, “Eliminating Tumour Cells from the Cell Saver (CS) in Metastatic Spine Tumour Surgery Using a Leucocyte Depletion Filter (LDF): Dispelling an Old Myth”, N. Kumar, Y. Chen, Q. Ahmed, V. K. M. Lee, A. S. Zaw, R. Goy, H. K. Wong was awarded the Kostuik Innovation Award at the International Society for Advancement of Spine Surgery (ISASS13) Tier 1 Spine meeting in Vancouver, Canada, April 3–5 2013.

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Kumar, N., Ahmed, Q., Lee, V.K.M. et al. Can There be a Place for Intraoperative Salvaged Blood in Spine Tumor Surgery?. Ann Surg Oncol 21, 2436–2443 (2014). https://doi.org/10.1245/s10434-014-3569-x

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