title: [Perioperative autotransfusion with salvage blood in cancer  surgery]  .
abstract: OBJECTIVE
  Intraoperative blood cells salvage using a Cell Saver technique is controversial in oncologic surgery because tumor cells could be aspirated and reinfused to the patient. The goal of this review was to discuss the risk associated with this technique, and the way to minimize it.
  
  
  METHODS
  A review of the literature has been made by questioning PubMed site (http://nbci.nlm.nih.gov) on the period of 1968 to 2000. The key words were: intraoperative blood salvage, blood transfusion, autologous, cancer. Cases reports have been excluded.
  
  
  METHODS
  Tumor cells aspirated and reinfused have been numbered in both experimental and clinical studies. In clinical studies, the outcome after intraoperative cells salvage/reinfusion has been compared to published data or historical groups of allogeneic transfusion, all in non randomized studies.
  
  
  RESULTS
  Both experimental and clinical studies confirmed the presence of cancer cells in the blood either aspirated or reinfused. However, six clinical studies with limited number of patients did not show metastatic spread associated with Cell Saver. The addition of leukocyte filters reduces greatly this quantity of cancer cells. Irradiation of the pack did not destroy tumor cells but blocked their proliferative capacity. In the other hand, some infiltrative tumors were shown to have permanent cancer cells seeding, quantitatively superior to the seeding observed when a Cell Saver is used.
  
  
  CONCLUSIONS
  It seems reasonable to use the Cell Saver in oncologic surgery, if possible with a leukocyte filter, not only in case of unexpected major bleeding (consensus), but also in programmed cases with high risk of huge hemorrhage.
authors.affiliation: Service de chirurgie carcinologique générale, institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif, France. elias@igr.fr
authors.forename: D
authors.initials: D
authors.lastname: Elias
authors.forename: V
authors.initials: V
authors.lastname: Lapierre
authors.forename: V
authors.initials: V
authors.lastname: Billard
mesh_terms: D001804:Blood Transfusion, Autologous / Q000009:adverse effects; D005374:Filtration; D006801:Humans; D001239:Inhalation; D007432:Intraoperative Period; D009369:Neoplasms / Q000473:pathology / Q000601:surgery*; D018570:Risk Assessment
vernacular_title: Autotransfusion peropératoire par récupération de sang épanché en chirurgie carcinologique.