Objective:To assess the impact of intra-operative cell salvage on outcomes in open nephrectomy. Methods: A retrospective cohort study was performed of all patients undergoing open nephrectomy for suspected malignancy from 1 October 2013 to 1 October 2017. Patients were grouped and compared based on whether they received intra-operative cell salvage (ICS). Primary outcomes were allogeneic transfusion rates (ATRs), and if histology confirmed cancer, disease recurrence. Secondary outcomes were complications and transfusion-related cost. Results: Forty patients underwent open nephrectomy for suspected malignancy during the enrolment period. Sixteen patients received ICS while 24 did not (standard group). Compared with the standard group, ICS patients had similar median age (63.5 vs. 61.0 years; p = 0.83) but fewer females (19% vs. 58%; p = 0.013). The groups were similar in pre-operative and discharge haemoglobin, Charlson Comorbidity Index, length of hospital stay and proportion with thoracoabdominal surgical approach. The ICS group had a smaller proportion undergoing partial nephrectomy (19% vs. 54%; p = 0.025) and shorter median follow-up (278 vs. 827 days; p = 0.0005). Histology was malignant for 14 ICS and 15 standard patients. The ICS group had more frequent ≥T2 disease (79% vs. 27%; p = 0.005). There were no positive margins. Both groups had similar ATRs (6% vs. 4%; p = 0.96), complication rates (19% vs. 29%; p = 0.46) and recurrence rates (18% vs. 7%; p = 0.40). Transfusion costs were higher amongst ICS patients (AUD $878.18 vs. $49.65 per patient). Conclusion: ICS appears safe, with low rates of recurrence and complication. Both groups had low ATRs, and therefore cost benefit for ICS was not seen.
. [J]. Asian Journal of Urology, 2019, 6(4): 346-352.
Ned Kinnear,Lina Hua,Bridget Heijkoop,Derek Hennessey,Daniel Spernat. The impact of intra-operative cell salvage during open nephrectomy. Asian Journal of Urology, 2019, 6(4): 346-352.
Anticoagulant; 2 ampoules of 25 000 units/5 mL heparin
2.13
ICS machine tubing
1.10
1 × 1000 mL 0.9% normal saline
72.50
ICS reservoir
4.54
Bacterial filter
488.46
Anaesthetic nurse wages per case
609.85
Sub-total, ICS setup cost
56.00
Leucocyte depletion filter; Haemonectics? RS1VAE
280.00
ICS processor set
35.00
Reinfusion bag
11.00
10 × 1000 mL 0.9% normal saline per 500 mL reinfused @$1.10/bag
382.00
Sub-total, ICS reinfusion cost
Index
ICS
Standard
p-Value
Demographics
Patients (n)
16
24
Age (year), median (IQR)
63.5 (56-70)
61 (51-71)
0.83
Female, n (%)
3 (19%)
14 (58%)
0.013
Pre-operative haemoglobin (g/L), median (IQR)
144 (114-152)
139 (133-149)
0.99
Post-operative haemoglobin (g/L), median (IQR)
120 (95-127)
112 (101-125)
0.86
Charlson Comorbidity Index, median (IQR)
4 (2-5)
3 (2-5)
0.35
Length of stay (day), median (IQR)
7 (5-7)
7 (6-9)
0.42
Follow-up (day), median (IQR)
278 (130-554)
827 (549-1319)
0.0005
Approach
Thoracoabdominal, n (%)
14 (88%)
19 (79%)
0.50
Left-sided tumour, n (%)
7 (44%)
10 (42%)
0.90
Radical, n (%)
13 (81%)
11 (46%)
0.025
Index
ICS (n = 16)
Standard (n = 24)
p-Value
Histology a
Malignant
14
15
Renal cell carcinoma, n (%)
12 (86)
11 (73)
N/A
Size (mm), median (IQR)
63 (31-111)
27 (22-69)
0.11
Margin positive, n (%)
0 (0)
0 (0)
N/A
Tumour stage ≥T2, n (%)
11 (79)
4 (27)
0.005
Nodal stage N1, n (%)
1 (7)
1 (7)
1
Metastasis stage M1, n (%)
3 (21)
1 (7)
0.25
Outcomes a
Patients with allogeneic transfusion, n (%)
1/16 (6)
1/24 (4)
0.96
Malignant and M0, disease recurrence, n (%)
2/11 (18)
1/14 (7)
0.40
Complications, n (%)
3/16 (19)
7/24 (29)
0.46
Transfusion-related cost (AUD, $)
878.18
49.65
N/A
C-D grade
Patients and histology details
Intra-operative cell salvage group
Self-limiting asymptomatic fever
1
62yr M CCI 4, 15 mm T1N0M0
Self-limiting asymptomatic hyperkalaemia
1
74yr M CCI 7, 60 mm T3N0M0
Persistent high drain outputs. Drain left in-situ on discharge and removed subsequently in outpatients
3a
74yr M CCI 9, 70 mm T3N0M1
Standard group
Self-limiting asymptomatic fever
1
51yr M CCI 3, 70 mm T3N0M0
Self-limiting asymptomatic hypoxia
1
84yr F CCI 8, 85 mm T3N1M1
Post-operative ileus, resolved without nasogastric tube
1
69yr M CCI 4, 15 mm oncocytoma
Hospital acquired pneumonia + rotavirus-positive diarrhea, treated with antibiotics and supported therapy
2
66yr M CCI 3, 28 mm oncocytoma
Angina pectoris with normal investigations
2
70yr F CCI 5, 37 mm T1N0M0
Small pneumothorax post-underwater sealed drain removal; resolved with conservative management
3a
88yr F, CCI 5, benign atrophic kidney
Intra-operative laceration to proximal ureter anterior wall during partial nephrectomy, managed with ureteric stent for 6 weeks
3a
71yr M CCI 3, 22 mm T1N0M0
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