Table 1.
Key papers evaluating the use of IOCS in various cancer surgeries
| Study | Country | Type of study | No. of patients | Level of evidence | Follow-up | Outcomes | |
|---|---|---|---|---|---|---|---|
| Gynaecology | |||||||
| Connor et al. [42] (1995) | USA | Prospective cohort | IOCS (31), Non-IOCS (40) | 3 | Mean 24 months | IOCS decreases the need for ABT intra- and postoperatively. IOCS does not appear to reinfuse tumour cells in patients undergoing radical hysterectomy for cervical cancer | |
| Mirhashemi et al. 68] (1999) | USA | Retrospective cohort | IOCS (50), Non-IOCS (106) | 3 | Mean 22 months | IOCS group (12%) received significantly less ABT as compared to non-IOCS group (30%) (p = 0.02). No significant differences between IOCS and non-IOCS group across all 11 postoperative complications studied. | |
| Catling et al. [25] (2008) | UK | Prospective observational | IOCS (50) | 2 | NA | No viable, nucleated malignant cells were detectable in any of the final, filtered samples of cell salvaged blood. | |
| Hepatobiliary | |||||||
| Fujimoto et al. [44] (1991) | Japan | Prospective cohort | IOCS (54), ABT (50) | 3 | Until death or predefined study end date (Dec 1991) | Mean volume of allogeneic blood transfused was significantly less in IOCS group (814±397 mL) vs. ABT group (3,466±1,811 mL); (p<0.05). No significant differences between IOCS and ABT groups in terms of: | |
| - Cumulative recurrence rates (62.8% vs. 67.3%) | |||||||
| - Cumulative survival rates (61.9% vs. 52.8%). | |||||||
| Muscari et al. [73] (2005) | France | Prospective cohort | IOCS (31), Non-IOCS (16) | 3 | Median (months): IOCS (48), Non-IOCS (15) | No significant difference in tumour recurrence rates between IOCS (6.4%) vs. non-IOCS (6.3%) groups | |
| Foltys et al. [43] (2011) | Germany | Prospective cohort | IOCS (40), Non-IOCS (96) | 3 | Median (days): IOCS (1,146), non-IOCS (877) | No significant difference in tumour recurrence rates between IOCS (5 of 40 patients or 13%) vs. non-IOCS (18 of 96 or 19%) groups (p = 0.29) | |
| Kim et al. [46] (2013) | Korea | Retrospective cohort | IOCS (121), Non-IOCS (109) | 3 | Median (months): IOCS (53), non-IOCS (33) | No significant difference in recurrence-free survival rates between IOCS (83.3%) vs. non-IOCS (77.4%) groups (p = 0.31). Average number of allogeneic blood transfused was significantly less in IOCS group (3.7 units) vs. non-IOCS group (9.9 units); (p<0.01). | |
| Han et al. [87] (2016) | Korea | Retrospective Cohort | IOCS (283), Non-IOCS (114) | 3 | 5 Years | Cumulative posttransplantation HCC recurrence rate at 1, 2, and 5 years were 10.4% (5.3%–17.6%), 19.1% (11.6%–28.0%), and 24.1% (15.2%–34.0%) for non-autotransfusion group and 10.8% (7.2%–15.4%), 14.9% (10.5%–20.0%), and 20.3% (14.9%–26.4%) for autotransfusion group, respectively. No significant impact of auto transfusion on posttransplant HCC recurrence. | |
| Araujo et al. [88] (2016) | Brazil | Retrospective Cohort | IOCS (122), Non-IOCS (36) | 3 | 5 Years | The OS & RFS at 5 years were 59.7% & 83.3%, respectively. No differences in OS (p = 0.51) or RFS (p = 0.953) were detected between the IOCS and non-IOCS groups. | |
| Gastrointestinal | |||||||
| Bower et al. [40] (2011) | USA | Prospective cohort | IOCS (32), Non-IOCS (60) | 3 | Median 18 months | At median follow-up, no significant difference between IOCS group and non-IOCS group in terms of: | |
| - Overall recurrence rates (28% vs. 43%，p = 0.9) | |||||||
| - Pancreatic cancer recurrence rates (33% vs. 24%, p = 0.7) | |||||||
| - Loco-regional recurrence rates (22% vs. 17%, p = 0.58) | |||||||
| - Distant recurrence rates lower in IOCS vs. non-IOCS group, although not statistically significant (16% vs. 25%, p = 0.427) | |||||||
| Urology | |||||||
| Park et al. [71] (1997) | Japan | Prospective cohort | IOCS (6), IOCS+PAD (4) | 3 | Mean 47 months | IOCS seems feasible in reducing or avoiding ABT in radical cystectomy. IOCS+PAD will abolish the need for ABT in radical cystectomy | |
| Gray et al. [50] (2001) | USA | Prospective cohort | IOCS-LDF (62), PAD (101) | 3 | Mean (months): IOCS-LDF group (7), PAD group (43) | No significant difference in progression-free survival between PAD and IOCS-LDF groups (p = 0.41). ABT requirements were significantly lower in the IOCS-LDF group (3%) vs. the PAD (14%) group (p = 0.04) | |
| Davis et al. [48] (2003) | USA | Retrospective cohort | IOCS (87), PAD (264), No transfusion (57) | 3 | Mean 40.2 months | No significant difference in biochemical recurrence rates between the IOCS (15%), PAD (16%) and No transfusion (19%) groups (p = 0.784). IOCS was less likely to have recurrence in comparison to: | |
| - PAD group (OR, 0.81; 95% CI, 0.33–2.00) | |||||||
| - No transfusion group (OR, 0.66, 95% CI, 0.21–2.08) | |||||||
| Neider et al. [51] (2005) | USA | Retrospective cohort | IOCS (265), Non-IOCS (773) | 3 | Median (months): IOCS (40.3), non-IOCS (44.4) | No significant difference in biochemical recurrence rates at 5 years between the IOCS group (15%) vs. Non-IOCS group (18%) (p = 0.76). No significant difference in recurrence-free survival between IOCS group (27.9 ± 30.3 months) vs. non-IOCS group (32.1 ± 29.5 months) (p = 0.49) | |
| Stoffel et al. [54] (2005) | USA | Prospective cohort | IOCS (48), Non-IOCS (64) | 3 | Mean (months): IOCS (46), non-IOCS (43) | Cox regression showed that advanced pathological stage & Gleason score but not IOCS were independent predictors of biochemical failure. IOCS: Adjusted hazard ratio for biochemical recurrence 0.766 (p = 0.54). | |
| Nieder et al. [52] (2007) | USA | Retrospective cohort | IOCS (65), non-IOCS (313) | 3 | Median (months): IOCS (19.1), non-IOCS (20.7) | No significant difference in disease-specific survival rate for IOCS and non-IOCS groups: 72.2% and 73.0% respectively (p = 0.9). IOCS is a safe blood management method for patients undergoing radical cystectomy. | |
| Ford et al. [49] (2008) | USA | Prospective cohort | IOCS (252), ABT(117), No transfusion (242) | 3 | Mean 44 months | No significant difference in biochemical progression-free survival rates at 5 years between no transfusion (86%), IOCS 90%) & ABT groups (84%) (p = 0.42). No significant difference in biochemical failure rates between IOCS (10%), ABT (16%) and no transfusion (14%) (p = 0.42). | |
| Ubee et al. [89] (2011) | UK | Prospective cohort | IOCS (25), non-IOCS (25) | 3 | 3 Months | 16% in non-IOCS group had biochemical recurrence vs. 4% in IOCS group. 20% of patients in IOCS group received a total of 16 units of homologous blood whereas 72% in non-IOCS group received a total of 69 units. No evidence that IOCS increased the risk of early biochemical relapse or tumour dissemination. | |
| Gorin et al. [55] (2012) | USA | Retrospective cohort | IOCS (395), non-IOCS (1,467) | 3 | Median (months): IOCS (47), non-IOCS (48) | IOCS group had 5 and 8-year BCR-free survivals of 82.4 and 73.4%, respectively whereas non-IOCS group had survivals of 83.7 and 76.6%, respectively (p = 0.32). 0.6% of patients in IOCS group required ABT vs. 3%-20% in non-IOCS group. IOCS use was not associated with an increased risk of BCR and decrease in overall survival. | |
| Raval et al. [90] (2012) | USA | Retrospective cohort | IOCS (63), PAD (53) | 3 | Mean (days): IOCS (1,857), PAD (1,977) | Patients with biochemical recurrence was significantly fewer in the IOCS group (9.5%) than PAD group (34.4%) (p = 0.02). Patients with evidence of metastatic disease were significantly fewer in the IOCS group (0%) than PAD group (12.5%) (p = 0.03) | |
| Lung | |||||||
| Perseghin et al. [47] (1997) | Italy | Prospective observation- al | IOCS (16) | 3 | NA | Tumour cells were detected in 9 of 16 (56%) samples post-IOCS. In the post-LDF samples, only cell debris or occasional damaged mononuclear cells were detectable. No malignant tumour cells were detected. | |
| Prostate | |||||||
| Chalfin et al. [91] (2014) | USA | Retrospective cohort | IOCS only (5,124), ABT±IOCS (258), NBT (2,061) | 3 | Median 6 years | In multivariable models, neither autologous nor allogeneic BT was independently associated with BRFS, CSS, or OS. | |
IOCS, intraoperative cell salvage; ABT, allogeneic blood transfusion; NA, not available; HCC, hepatocellular carcinoma; NBT, no blood transfusion; PAD, preoperative autologous donation; LDF, leucocyte depletion filter; OR, odds ratio; CI, confidence interval; BRFS, biochemical recurrence-free survival; CSS, cancer-specific survival; OS, overall survival; RFS, recurrence-free survival.