van der Ven Ward H, Hollmann Markus W
Department of Anesthesiology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Laboratory of Experimental Intensive Care and Anesthesiology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
J Clin Med. 2025 Jul 7;14(13):4786. doi: 10.3390/jcm14134786.
Intraoperative cell salvage (ICS) is a blood conservation technique utilized in major surgery, yet its application in oncologic procedures remains debated. Concerns persist about the theoretical risk of metastasis through reinfusion of tumor cells, despite the established disadvantages of allogeneic blood transfusion (ABT), such as transfusion-related reactions and immunosuppression. In this review, we discuss the historical development of ICS, the technical processes of ICS including leukocyte depletion filtration and irradiation, and experimental and clinical data regarding its safety and efficacy. In vitro studies suggest that tumor cells undergo significant structural alterations during ICS processing, and additional filtration further reduces cell load, although complete removal is not always achieved. Observational studies of predominantly moderate quality, aggregated in multiple systematic reviews, consistently report no increased recurrence rates or reduced disease-free and overall survival in patients receiving ICS. Accordingly, national and international guidelines endorse the use of ICS during oncologic surgery. Although high-quality data-preferably from randomized controlled trials-are lacking, and certainty of available evidence from observational studies is low, ICS appears to be effective and safe. The broader adoption of its use during oncologic surgery may be warranted to minimize reliance on ABT and its associated risks.
术中自体血回输（ICS）是一种在大型手术中使用的血液保护技术，但其在肿瘤手术中的应用仍存在争议。尽管异体输血（ABT）存在诸如输血相关反应和免疫抑制等既定缺点，但对于通过回输肿瘤细胞导致转移的理论风险，人们仍然存在担忧。在本综述中，我们讨论了ICS的历史发展、ICS的技术流程，包括白细胞去除过滤和辐照，以及关于其安全性和有效性的实验和临床数据。体外研究表明，肿瘤细胞在ICS处理过程中会发生显著的结构改变，额外的过滤进一步降低了细胞负荷，尽管并不总是能完全清除。在多个系统评价中汇总的主要为中等质量的观察性研究一致报告，接受ICS的患者复发率没有增加，无病生存期和总生存期也没有缩短。因此，国家和国际指南认可在肿瘤手术中使用ICS。尽管缺乏高质量数据，最好是来自随机对照试验的数据，且观察性研究现有证据的确定性较低，但ICS似乎是有效且安全的。在肿瘤手术中更广泛地采用ICS可能是必要的，以尽量减少对ABT及其相关风险的依赖。
