Abstract
Introduction
Metastatic oncological surgery is associated with substantial blood loss. Allogeneic blood is the current method for blood replenishment but it has been associated with significant side effects such as: transmission of infections, immunosuppression and other transfusion reactions. Autologous salvaged blood can be a good alternative; yet, it has been contraindicated in oncological surgeries for theoretical concern of reinfusing tumor cells and thereby causing tumor dissemination. We aimed to investigate whether there is any supporting evidence that can logically address the concerns of autologous salvaged blood transfusion in metastatic oncological surgery.
Materials and Methods
We searched and reviewed the literature through the electronic database – Medline, Scopus, Web of Science and Google Scholar for relevant publications from the past 20 years (January 1 1993 to December 31 2014). We also supplemented the results by searching related key articles from before this period. Relevant articles were selected using search terms: “cancer surgery,” “intraoperative cell salvage,” “autologous salvaged blood” “leucocyte depletion filter,” “circulating tumour cells,” “leucocytes” and “white blood cells.”
Results
The benefits of transfusion of salvaged blood over allogeneic blood were clearly appreciated in various oncological surgeries. Salvaged blood was comparable or non-inferior to allogeneic blood in terms of safety. In view of the existing circulating tumor cells in the patients with metastatic cancer diseases, the theoretical concern of re-infusing malignant cells from the salvaged blood does not seem to be logical. The reinfusion of salvaged blood was not found to worsen outcomes - tumor dissemination or distant metastases in patients receiving it. It was also found that preserving of white blood cells in the salvaged blood seemed to add benefits in promoting rapid immune recovery in the cancer patients.
Conclusions
There is evidence supporting the use of salvaged blood in various oncological surgeries. It was advocated that transfusion of salvaged blood is economically efficient, clinically effective and attractive alternative to other transfusion methods. Better understandings and evidence on the preserving white blood cells in the filtered salvaged blood would provide further advantages of salvaged blood in having rapid immune recovery in cancer patients.