title: Are we ready for the use of intraoperative salvaged blood in metastatic spine tumour surgery?
abstract: To evaluate the feasibility of using intraoperative cell salvage (IOCS) in combination with leucocyte depletion filter (LDF) in eliminating tumour cells from blood salvaged during metastatic spine tumour surgery (MSTS). This is with the view to pave the path for use of IOCS-LDF in MSTS and musculoskeletal oncological surgery.
  
  
  
  Sixty consecutive patients with known primary epithelial tumour, who were offered surgery for metastatic spine disease at our university hospital, were recruited. Blood samples were collected at three different stages during surgery: from operative field prior to IOCS processing, after IOCS processing and after IOCS-LDF processing. Three separate samples (5 ml each) were taken at each stage. Samples were examined by cell block technique using immunohistochemical monoclonal antibodies to identify tumour cells of epithelial origin in the samples.
  
  
  
  Of 60 patients, ten were excluded for not fulfilling the inclusion criteria leaving 50 patients. Malignant tumour cells were detected in the samples from operative field prior to IOCS processing in 24 patients and in the samples from the transfusion bag post-IOCS processing in 4 patients. No viable malignant cells were detectable in any of the blood samples after passage through both IOCS and LDF.
  
  
  
  The findings support the notion that IOCS-LDF combination works effectively in eliminating tumour cells from salvaged blood so this technique can possibly be applied in MSTS and even musculoskeletal oncological surgery. This concept can then be extended to other oncological surgeries in general with further appropriate clinical studies.
authors.affiliation: Department of Orthopaedic Surgery, National University Health System, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119228, Singapore. dosksn@nus.edu.sg.
authors.forename: Naresh
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Pathology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
authors.forename: Qasim
authors.initials: Q
authors.lastname: Ahmed
authors.affiliation: Department of Pathology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
authors.forename: Victor K M
authors.initials: VK
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, National University Health System, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119228, Singapore.
authors.forename: Aye Sandar
authors.initials: AS
authors.lastname: Zaw
authors.affiliation: Department of Anaesthesia, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
authors.forename: Raymond
authors.initials: R
authors.lastname: Goy
authors.affiliation: Department of Orthopaedic Surgery, National University Health System, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119228, Singapore.
authors.forename: Hee Kit
authors.initials: HK
authors.lastname: Wong
mesh_terms: D002469:Cell Separation; D005240:Feasibility Studies; D005374:Filtration; D006801:Humans; D009362:Neoplasm Metastasis; D009360:Neoplastic Cells, Circulating; D057725:Operative Blood Salvage / Q000379:methods*; D013125:Spinal Neoplasms / Q000601:surgery*
keywords: Intraoperative cell salvage; Leucocyte depletion filter; Metastatic spine tumour surgery; Oncological surgery; Tumour cells