Does Intraoperative Cell-Salvaged Autologous Blood Transfusion in Metastatic Spine Tumour Surgery Impact Clinical Outcomes: A Prospective Clinical Study With 4-year Follow-Up.

Abstract

Study design: Prospective Clinical Study.

Objective: Allogeneic blood transfusion (ABT) is the current standard of blood replenishment for metastatic spine tumour surgery (MSTS) despite known complications. Salvaged blood transfusion (SBT) addresses majority of complications related to ABT. We aim to conduct a prospective clinical study to ascertain the long-term clinical outcomes of intraoperative cell salvage (IOCS) in MSTS.

Methods: Patients were divided into three groups based on their BT type: no blood transfusion (NBT), ABT and SBT. Primary outcomes assessed were overall survival (OS) and tumour progression (TP), evaluated using RECIST (v1.1) employing follow-up radiological investigations at 6, 12, 24, 36 and 48 months.

Results: We included 98 patients [53:45 (M/F)] with mean age of 60 years old. 33 (33.7%) patients received SBT, 39 (39.8%) received ABT and 26 (26.5%) had NBT. All BT groups were comparable for demographics and tumour characteristics (P = 0.215). Median blood loss was 400 mL and median BT was 620 mL. There were no significant differences between OS of patients who underwent SBT, as compared to ABT or NBT (P = 0.136). On multivariate analysis, SBT did not show increase in 4-year tumour progression (P = 0.423). Total blood loss was not associated with tumour progression (P = 0.260).

Conclusions: MSTS patients who had SBT showed comparable OS and TP to ABT and NBT even on long term follow-up. This is the first long term prospective study to report on the clinical outcomes of SBT in comparison with control groups in MSTS and affirms the clinical role of SBT in MSTS.