Intraoperative cell salvage reduces the need for allogeneic
blood transfusion in complex
cancer surgery, but concerns about the possibility of it re-infusing
cancer cells have hindered its application in oncology. We monitored the presence of
cancer cells on patient-salvaged blood by means of flow cytometry; next, we simulated cell salvage, followed by leucodepletion and irradiation on blood contaminated with a known amount of
EpCAM-expressing
cancer cells, assessing also
residual cancer cell proliferation as well as the quality of salvaged red blood cell concentrates (RBCs). We observed a significant reduction of
EpCAM-positive cells in both
cancer patients and contaminated blood, which was comparable to the negative control after leucodepletion. The washing, leucodepletion and leucodepletion plus irradiation steps of cell salvage were shown to preserve the quality of RBCs in terms of
haemolysis, membrane integrity and osmotic resistance. Finally,
cancer cells isolated from salvaged blood lose their ability to proliferate. Our results confirm that cell salvage does not concentrate proliferating
cancer cells, and that leucodepletion allows for the reduction of residual nucleated cells, making irradiation unnecessary. Our study gathers pieces of evidence on the feasibility of this procedure in complex
cancer surgery. Nevertheless, it highlights the necessity of finding a definitive consensus through prospective trials.