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Title: Intra-operative cell salvage in urological surgery; a systematic review and meta-analysis of comparative studies.
Austin Authors: Kinnear, Ned J;O'Callaghan, Michael;Hennessey, Derek B;Liddell, Heath;Newell, Bradley;Bolt, John;Lawrentschuk, Nathan
Affiliation: Department of Urology, Austin Health, Heidelberg, Victoria, Australia
Department of Urology, Royal Adelaide Hospital, Adelaide, Australia
South Australian Prostate Cancer Clinical Outcomes Collaborative, Flinders Medical Centre, Adelaide, Australia
School of Medicine, University of Adelaide, Adelaide, Australia
Flinders Centre for Innovation in Cancer, Adelaide, Australia
Department of Urology, Craigavon Area Hospital, Portadown, United Kingdom
Department of Urology, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Australia
Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
Issue Date: 3-May-2018 2018-05-03
Publication information: BJU International 2018; online first: 3 May
Abstract: To systematically evaluate the safety and efficacy of intra-operative cell salvage (ICS) in urology. A search of Medline, Embase and Cochrane Library to August 2017 was performed using methods pre-published on PROSPERO. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Eligible titles were comparative studies published in English utilising ICS in urology. Primary outcomes were allogeneic transfusion rates (ATR) and tumour recurrence. Secondary outcomes were complications and cost. Fourteen observational studies were identified, totaling 4,536 patients. ICS was compared to no blood conservation technique (seven studies), pre-operative autologous donation (PAD) (five) or both (two). Cohorts underwent open prostatectomy (eleven studies), open cystectomy (two) or open partial nephrectomy (one). Meta-analysis was possible only for ATR within prostatectomy studies. In this setting, ICS reduced ATR compared with no blood conservation technique (OR 0.34, 95% CI 0.15-0.76) but not PAD (OR 0.76, 95% CI 0.39-1.31). In the non-prostatectomy setting, ATR amongst ICS patients was significantly higher or similar in one and two studies respectively. Tumour recurrence was found to be significantly less common (two studies), similar (eight) or not measured (four). All six studies reporting complications found no difference for ICS cohorts. Regarding cost, one study from 1995 found ICS more expensive than PAD, while two more recent studies found ICS cheaper than no blood conservation technique. Due to inter-study heterogeneity, meta-analyses were not possible for recurrence, complications or cost. Low level evidence exists that compared with other blood conservation techniques, ICS reduces ATR and cost while not affecting complications. It does not appear to increase tumour recurrence post-prostatectomy, although follow-up durations are short. Small size and short follow-up negate conclusions on recurrence following nephrectomy or cystectomy. Randomised trials with long term follow-up evaluating ICS in urology are required. This article is protected by copyright. All rights reserved.
DOI: 10.1111/bju.14373
ORCID: 0000-0002-7833-2537
PubMed URL: 29726092
Type: Journal Article
Subjects: autologous blood
cell salvage
intra-operative cell salvage
Appears in Collections:Journal articles

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