General Session: Tumor, Trauma, Infection - Hall F

Presented by: N. Kumar

Author(s):

N. Kumar(1), J. Tan(1), D. Sonnawane(1), R. Patel(1), R. Nivetha(1)

(1) National University Health System, Orthopaedics, Singapore, Singapore

Abstract

Summary of Background Data: Salvaged blood transfusion has not found wide application in MSTS due to the theoretical concern of reinfusing tumour cells resulting in tumour dissemination; despite its routine use in spinal surgeries for degenerative conditions and deformity. We have previously reported our laboratory studies on the safety of the blood salvaged during MSTS. Spine surgeons, however, remain reluctant to employ IOCS because of the lack of clinical data addressing the concerns of tumor dissemination.

Methods: We prospectively analyzed 42 patients who underwent MSTS between January2014 and January2016. Patients were divided into three groups depending on transfusion history: (i )no blood transfusion(NBT) group (ii) salvaged blood transfusion (SBT) group and (iii) allogeneic blood transfusion(ABT) group. Primary outcome measure was progression-free survival (PFS) rates comparing between the three groups. Overall survival (OS), postoperative complication rates and length of hospital stay (LOS) were also studied as secondary outcomes.

Results: There was a trend towards better PFS and OS rates in SBT group compared to ABT or NBT group though the differences were not significant. Univariate and multivariate Cox regression analyses revealed that primary tumour type and ECOG performance status were the factors significantly influencing PFS. Transfusion status did not increase the risk of tumour progression. Postoperative complication rates and length of stay were also favourable in SBT group compared to ABT and NBT group.

Conclusion: Patients who received salvaged blood transfusion had comparable outcomes in terms of tumour progression and survival to those who received allogeneic blood. Our study paves a path for larger cohort or randomized study where salvaged blood transfusion can be evaluated for its appropriateness and efficacy in patient blood management for oncological surgeries.