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. STUDY DESIGN AND 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 I2 (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.