Blood salvage and cancer surgery: a meta-analysis of available studies.
BACKGROUND
Intraoperative blood salvage (IBS) is a technique that is frequently used in major blood loss surgery. Classically, it is avoided during cancer surgery where a fear exists of entraining cancer cells into the shed blood. In this study, all reports of this practice were collected to determine if this fear is warranted.


METHODS
A literature search was performed including the search phrases "blood salvage,""intraoperative blood salvage,""cell salvage,""cell saver,""cell saving,""autotransfusion," and "autologous transfusion." Data extracted from suitable papers included the authors' names, publication year, cancer type, exclusion criteria, sample size, length of follow-up, and the mean patient age. The primary endpoint of this meta-analysis was a comparison of the odds ratio (OR) for cancer recurrence or the development of metastases.


RESULTS
Eleven studies were included in the analysis. The pooled summary of the OR was 0.65 (95% confidence interval, 0.43-0.98; p = 0.0391) using a random-effects model. Measures of heterogeneity, Q-statistics (p= 0.1615) and I(2) (30.90%), did not indicate a high degree of between-study variability.


CONCLUSIONS
While significant variability existed between studies, this meta-analysis suggests that outcomes after the use of IBS are not inferior to traditional intraoperative allogeneic transfusion. An adequately powered prospective, randomized trial of IBS use is required to determine its true risk during cancer surgery.
Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Jonathan H
JH
Waters
Mark
M
Yazer
Yi-Fan
YF
Chen
John
J
Kloke
D001803:Blood Transfusion; D001804:Blood Transfusion, Autologous / Q000009:adverse effects; D000075202:Contraindications; D005260:Female; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis / Q000517:prevention & control*; D009364:Neoplasm Recurrence, Local; D009369:Neoplasms / Q000097:blood / Q000601:surgery*; D009360:Neoplastic Cells, Circulating; D016017:Odds Ratio; D057725:Operative Blood Salvage / Q000009:adverse effects*; D012306:Risk; D016896:Treatment Outcome