Kumar N, Zaw A S, Kantharajanna S B, Khoo B L, Lim C T, Thiery J P
Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.
BioSystems and Micromechanics (BioSyM) Inter-Disciplinary Research Group, Singapore MIT Alliance for Research and Technology (SMART), National University of Singapore, Singapore, Singapore.
Transfus Med. 2017 Oct;27 Suppl 5:327-334. doi: 10.1111/tme.12453. Epub 2017 Aug 23.
The use of salvaged blood in oncological surgery has been a matter of controversy over the years. This is due to the concern of systemic dissemination of reinfused tumour cells. Recent literature, across disciplines, has shed considerable light on its safety in terms of tumour recurrence, progression and overall survival rates. This clinical safety demonstrates the apparent metastatic inefficiency of reinfused tumour cells. The proof of this concept comes from various studies that have shown that salvaged blood has no tumour cells, or has a significantly lower count as compared to the patient's original circulatory tumour load. Recently, we took a step further and found that the tumour cells in the salvaged blood lose the capacity to replicate. In this review, we revisited the safety of salvaged blood from the point of view of metastatic potential. We have presented basic and applied science evidence regarding the innocuous nature of tumour cells that have been subjected to the cell salvage process. The understanding of the metastatic efficiency or the lack of it in tumour cells subjected to salvage process is key to allay the concerns conventionally associated with the use of salvaged blood in tumour surgery. Based on the available literature, we surmise that the prevalent apprehensions on the usage of salvaged blood are ill-founded and further substantiate why tumour cells in the salvaged blood could be regarded as cells with non-metastatic potential.
多年来，肿瘤手术中使用回收血一直存在争议。这是因为人们担心再输注的肿瘤细胞会发生全身播散。近期跨学科的文献就回收血在肿瘤复发、进展及总生存率方面的安全性提供了大量信息。这种临床安全性表明再输注的肿瘤细胞明显缺乏转移效率。这一概念的证据来自多项研究，这些研究表明回收血中没有肿瘤细胞，或者与患者原来循环中的肿瘤负荷相比，肿瘤细胞数量显著减少。最近，我们更进一步发现，回收血中的肿瘤细胞失去了复制能力。在这篇综述中，我们从转移潜能的角度重新审视了回收血的安全性。我们展示了有关经过细胞回收过程的肿瘤细胞无害性质的基础科学和应用科学证据。了解经过回收过程的肿瘤细胞的转移效率或缺乏转移效率，对于消除传统上与肿瘤手术中使用回收血相关的担忧至关重要。基于现有文献，我们推测，对使用回收血普遍存在的担忧是没有根据的，并进一步证实了为什么回收血中的肿瘤细胞可被视为无转移潜能的细胞。
