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Intra‐operative cell salvage in urological surgery: a systematic review and meta‐analysis of comparative studies
Author(s) -
Kinnear Ned,
O'Callaghan Michael,
Hennessey Derek,
Liddell Heath,
Newell Bradley,
Bolt John,
Lawrentschuk Nathan
Publication year - 2019
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14373
Subject(s) - medicine , meta analysis , prostatectomy , cochrane library , open prostatectomy , odds ratio , confidence interval , medline , nephrectomy , observational study , surgery , urology , systematic review , cystectomy , prostate cancer , bladder cancer , cancer , kidney , political science , law
Objective To evaluate systematically the safety and efficacy of intra‐operative cell salvage ( ICS ) in urology. Methods A search of Medline, Embase and Cochrane Library to August 2017 was performed using methods pre‐published on PROSPERO . Reporting followed the Preferred Reporting Items for Systematic Review and Meta‐analysis guidelines. Eligible titles were comparative studies published in English that used ICS in urology. Primary outcomes were allogeneic transfusion rates ( ATR s) and tumour recurrence. Secondary outcomes were complications and cost. Results Fourteen observational studies were identified, with a total of 4 536 patients. ICS was compared with no the blood conservation technique (seven studies), preoperative autologous donation ( PAD ; five studies) or both (two studies). Cohorts underwent open prostatectomy (11 studies), open cystectomy (two studies) or open partial nephrectomy (one study). Meta‐analysis was possible only for ATR s within prostatectomy studies. In this setting, ICS reduced ATR compared with no the blood conservation technique (odds ratio [ OR ] 0.34, 95% confidence interval [ CI ] 0.15–0.76) but not PAD ( OR 0.76, 95% CI 0.39–1.31). In the non‐prostatectomy setting, ATR s amongst patients who underwent ICS were significantly higher or similar in one and two studies, respectively. Tumour recurrence was found to be significantly less common (two studies), similar (eight studies) or not measured (four studies). All six studies reporting complications found no difference in their ICS cohorts. Regarding cost, one study from 1995 found ICS more expensive than PAD , while two more recent studies found ICS to be cheaper than no blood conservation technique. As a result of inter‐study heterogeneity, meta‐analyses were not possible for recurrence, complications or cost. Conclusion Low‐level evidence exists that, compared with other blood conservation techniques, ICS reduces ATR and cost while not affecting complications. It does not appear to increase tumour recurrence post‐prostatectomy, although follow‐up durations were short. Small study sizes and short follow‐ups mean conclusions cannot be drawn with regard to recurrence after nephrectomy or cystectomy. Randomized trials with long‐term follow‐up evaluating ICS in urology are required.