Should cell salvage be used in oncological surgery?

Cell salvage, the process whereby blood is suctioned from the surgical site then filtered, centrifuged and washed before being transfused, was first developed in 1974. Since then it has become a widely used technique which reduces the need for allogenic blood transfusion. Cell salvage was initially considered to be contraindicated in obstetrics, because of the risk of amniotic fluid emboli, in potentially 'dirty' surgical sites and in oncological surgery because of concerns about re-transfusion of malignant cells. However, cell salvage is now routinely used in obstetrics, particularly in massive haemorrhage, and in elective bowel resection. The potential use of cell salvage in oncological surgery has been highlighted following the National Institute for Health and Clinical Excellence (NICE, 2008) guidance sanctioning (although not specifically recommending) cell salvage during radical prostatectomy and cystectomy. This leads to the question of whether cell salvage is safe to use in these and other types of oncological surgery.