title: Extracorporeal tumor cell filtration during extended liver surgery: first clinical use of leukocyte depletion filters--case series.
abstract: BACKGROUND
  During oncologic surgery, intraoperative manipulation of tumor tissue is almost unpreventable and causes a high risk of tumor cell dissemination into venous blood. A tumor cell-reducing effect of leukocyte adhesion filter systems has been shown under in vitro conditions.
  
  
  METHODS
  In a first clinical attempt, leukocyte adhesion filters were integrated into veno-venous bypass systems in four patients undergoing extended liver surgery for secondary hepatic malignancies.Practicability, handling, and safety aspects as well as potency of cell removal and clinical side effects of the filter system were analyzed.
  
  
  RESULTS
  All patients tolerated the application of the system without problems during operative and postoperative follow-up. Immunohistochemical staining of perioperative blood samples detected cytokeratin positive (CK+) cells in three cases during the hepatic mobilization.
  
  
  CONCLUSIONS
  Effectiveness of CK+ cell depletion and safety of the procedure was shown. The presented surgical technique represents a safe and innovative tool; however, clinical significance has to be examined in a larger patient cohort.
authors.affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Rübenkamp 220, 22293 Hamburg, Germany. k.oldhafer@asklepios.com
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Oldhafer
authors.forename: Gregor A
authors.initials: GA
authors.lastname: Stavrou
authors.forename: Marcello
authors.initials: M
authors.lastname: Donati
authors.forename: Philipp
authors.initials: P
authors.lastname: Kaudel
authors.forename: Nils R
authors.initials: NR
authors.lastname: Frühauf
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D005112:Extracorporeal Circulation; D005260:Female; D005374:Filtration / Q000295:instrumentation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D047589:Leukocyte Reduction Procedures; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis