[Application of intraoperative cell salvage combined with leukocyte depletion filter on radical nephrectomy for renal carcinoma with inferior vena cava tumor thrombus: 2 case reports].

Intraoperative cell salvage (IOCS) has been widely used to reduce allogeneic blood transfusion and prevent blood transfusion related complications during surgery. However, due to the risk of transfusion related reaction, contamination, and immunological reaction, its use for tumor patients has been controversial and limited. To explore the feasibility of the application of IOCS in cancer patients, we reported 2 cases of renal cell carcinoma (RCC) with tumor embolism in IVC that underwent radical nephrectomy,and inferior caval venous thrombectomy receiving IOCS combined with leukocyte depletion filter (LDF) from August 2016 to November 2016 in our hospital. The cell saver blood salvage (Haemonetics, 5+) was used for these 2 cases. The salvaged blood was filtered through the LDF before infusion. For case 1 (male 45-year-old) the total operation time was 505 min, and the estimated blood loss was 4 500 ml. A total of 1 000 mL autologous blood, 12 u allogeneic packed red blood cells (PRBC), 1 200 mL fresh frozen plasma (FFP) were infused during the procedure. The patient was discharged from hospital after 75 days without complications. The postoperative follow-up for 3 months showed no tumor recurrence or metastasis. For case 2 (a male patient, aged 51 years), the total operation time was 490 min, and the estimated (blood loss was 7 000 mL. the patient received 2 700 mL autologous blood transfusion, 12 u allogeneic packed red blood cells (PRBC), and 2 400 mL fresh frozen plasma (FFP). The patient was discharged from hospital after 86 days without severe complications. the postoperative follow-up for 6 months showed no tumor recurrence or metastasis for this patient. Other relevant retrospective studies with this technique showed that cell salvage could be used safely in many kinds of cancer patients, for example, bladder cancer, liver cancer and kidney cancer. Furthermore,numerous researches have proved the safety and efficacy of the combination of these two techniques, the intraoperative cell salvage technique and leucocyte depletion filter in cancer patients. Here we only reported two cases using IOCS and LDF. Further work is needed to determine whether the use of intraoperative cell salvage combined with leukocyte depletion filter can be used safely for patients with HCC.