title: Can there be a place for intraoperative salvaged blood in spine tumor surgery?
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.
authors.affiliation: Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore, dosksn@nus.edu.sg.
authors.forename: Naresh
authors.initials: N
authors.lastname: Kumar
authors.forename: Qasim
authors.initials: Q
authors.lastname: Ahmed
authors.forename: Victor K M
authors.initials: VK
authors.lastname: Lee
authors.forename: Yongsheng
authors.initials: Y
authors.lastname: Chen
authors.forename: Aye Sandar
authors.initials: AS
authors.lastname: Zaw
authors.forename: Raymond
authors.initials: R
authors.lastname: Goy
authors.forename: Rohit Vijay
authors.initials: RV
authors.lastname: Agrawal
authors.forename: Aisha Naheed
authors.initials: AN
authors.lastname: Dhewar
authors.forename: Hee Kit
authors.initials: HK
authors.lastname: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D047589:Leukocyte Reduction Procedures; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology / Q000601:surgery*; D057725:Operative Blood Salvage / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*