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Evaluation of Intraoperative Autotransfusion Filtration for Hepatectomy and Pancreatectomy

¹ Division of Surgical Oncology, University of Louisville School of Medicine, 315 East Broadway, Room 313, Louisville, Kentucky 40202
² Department of Pathology, University of Louisville School of Medicine, Louisville, Kentucky 40202
³ UES Inc., Louisville, Kentucky, 40292

Correspondence: Address correspondence and reprint requests to: Robert C. G. Martin, MD; E-mail: robert.martin{at}louisville.edu

Background: Hepatectomy and pancreatectomy are often associated with significant in-traoperative blood loss leading to postoperative anemia, which has been demonstrated to lead to increased perioperative morbidity, a prolonged hospital stay, and decreased overall survival. Cancer has remained an absolute contraindication to autotransfusion because of the unproven concern about reinfusion of malignant cells. Thus, the aim of this study was to test for the presence of malignant cells in autotransfused filtered blood in patients undergoing major pancreatic and liver resection.

Methods: A prospective study of 20 consecutive patients evaluated the presence of malignant cells from autotransfusion filtered blood after resection by flow cytometric and immunohistochemical methods.

Results: Ten patients underwent major hepatectomy for metastatic colorectal cancer, with a median blood loss of 500 mL (range, 200–700 mL). Three patients received a total of six units of packed red blood cells. Ten patients underwent pancreaticoduodenectomy for adenocarcinoma with a median blood loss of 400 mL (range, 200–1300 mL). Five patients received a total of nine units of packed red blood cells. Flow cytometry did not demonstrate the presence of any cytokeratin-positive carcinoma cells in filtered blood.

Conclusions: Intraoperative autotransfusion for major hepatectomy in metastatic colorectal cancer and pancreatectomy for adenocarcinoma is safe and should begin to be evaluated in a phase II study for efficacy.

Key Words: Autotransfusion • Hepatectomy • Pancreatectomy • Surgical oncology • Liver neoplasms • Pancreatic neoplasms

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