TITLE: INTRAOPERATIVE CELL SALVAGE WITH AUTOTRANSFUSION IN PATIENTS UNDERGOING RADICAL RETROPUBIC PROSTATECTOMY

AUTHORS: Greg R. Polston, MD¹, Timothy J. Hannon, MD², Christine L. Gray, MD¹, Christopher L. Amling, MD¹, Christopher J. Kane, MD¹, David Leivers, MD¹
AFFILIATION: ¹Naval Medical Center, San Diego, CA; ²St. Vincent, Indianapolis, IN.

INTRODUCTION: Intraoperative cell salvage (ICS) with autotransfusion is not widely accepted in oncologic surgery due to the potential for reinfusion of viable tumor cells. Leukoreduction filters (LRF) may eliminate or significantly reduce the number of tumor cells from salvaged blood. We report our experience with ICS and autotransfusion using LRF in patients undergoing radical retropubic prostatectomy.
METHODS: Between 9/96 and 3/99, 62 consecutive patients with clinically localized prostate cancer underwent radical retropubic prostatectomy (RRP) with ICS using the Sequestra 1000 (Medtronics) as their sole blood management technique. During this era, 12 additional patients had blood loss too low to obtain adequate volume for transfusion. Salvaged blood was passed through a LRF (RC-400, Pall) prior to autotransfusion. The volume of retransfused blood ranged from 150 ml. to 1800 ml. (mean 534 ml.). Cell salvage patients (n = 62) were compared to a cohort of similar patients (n=101) who had predonated 1-3 units of autologous blood prior to RR-P. The two groups were compared with regard to estimated blood loss (EBL), preopera- tive and postoperative hematocit (Hct.), need for homologous transfusion and biochemical recurrence rates (prostatic specific antigen ÷ 0.2 ng/ml). Progression free survival was compared between the groups using Kaplan Meier graphical method.
RESULTS: There was no significant difference in preoperative PSA or pathologic stage between the cell salvage and autologous predonation groups. There was a I year age difference; the cell salvage group was younger. Gleason sum was 0.5 higher for the cell salvage group. Homologous transfusion rates were significantly lower for the cell salvage group.

Progression free survival was no different between the groups (p=0.94).

CONCLUSIONS: Intraoperative cell salvage and autotrans- fusion using LRF results in very low homologous transfusion rates and eliminates the need for autologous predonation prior to RRP. Cell salvage does not appear to be associated with an increased risk of early biochemical recurrence following RRP for clinically localized prostate cancer.