Metastatic Spine Tumour Surgery (MSTS) is a critical intervention for patients with metastatic spinal disease, aiming to alleviate spinal cord compression, pathological fractures, instability, and pain. However, MSTS often results in significant blood loss, leading to the necessity for blood transfusion. The current standard, allogeneic blood transfusion (ABT), comes with various risks, including immune-related complications, infections, and potential tumour progression. Intraoperative cell salvage (IOCS) offers an alternative by reusing the patient’s own blood, potentially reducing transfusion-related risks.
This prospective clinical study investigates the impact of salvaged blood transfusion (SBT) in MSTS on long-term clinical outcomes. Conducted at a single institution, it included 98 patients divided into three groups:
- No Blood Transfusion (NBT) – 26 patients (26.5%)
- Allogeneic Blood Transfusion (ABT) – 39 patients (39.8%)
- Salvaged Blood Transfusion (SBT) – 33 patients (33.7%)
The study assessed overall survival (OS) and tumour progression (TP) using the RECIST v1.1 criteria through radiological follow-ups at 6, 12, 24, 36, and 48 months. Additional parameters, including blood loss, complications, and length of hospital stay, were also evaluated.
Key Findings:
- Survival Outcomes: No significant difference was observed between OS in SBT, ABT, and NBT groups (p = 0.136). While univariate analysis suggested SBT might improve survival compared to ABT, multivariate analysis did not support this.
- Tumour Progression: SBT did not increase the risk of tumour progression over four years (p = 0.423).
- Blood Loss and Transfusion Volume: The median blood loss was 400mL, and the median transfusion volume for those who received blood was 620mL. The total amount of blood transfused was similar between SBT and ABT groups.
- Complications: No significant differences were found in surgical site infections (SSI), medical complications, or recurrence requiring additional surgery. ICU and hospital stay lengths were also comparable.
Implications for MSTS and Blood Management:
The study confirms that SBT is a safe and effective alternative to ABT, mitigating the risks associated with donor blood transfusions while ensuring adequate blood replenishment. These findings support the inclusion of SBT in standard blood management protocols for MSTS.
Strengths and Limitations:
The study’s strengths include its prospective design and four-year follow-up period. However, limitations include the lack of randomization, reliance on single-institution data, and a relatively small sample size. Future multi-center randomized trials could further validate these findings.
Conclusion:
Salvaged blood transfusion presents a viable and potentially advantageous alternative to allogeneic transfusion in metastatic spine tumour surgery. Given its comparable survival and tumour progression rates and the reduced risks associated with donor blood, SBT should be integrated into patient blood management strategies worldwide.
Study ranking = 4 (high-quality prospective study, but lacks randomization and multi-center validation).
