Objective: 

To evaluate the effect of intraoperative blood cell salvage and autotransfusion (IBSA) use on red blood cell (RBC) transfusion and postoperative outcomes in liver surgery.

Background: 

Intraoperative RBC transfusions are common in liver surgery and associated with increased morbidity. IBSA can be utilized to minimize allogeneic transfusion. A theoretical risk of cancer dissemination has limited IBSA adoption in oncologic surgery.

Methods: 

Electronic databases were searched from inception until May 2021. All studies comparing IBSA use with control in liver surgery were included. Screening, data extraction, and risk of bias assessment were conducted independently, in duplicate. The primary outcome was intraoperative allogeneic RBC transfusion (proportion of patients and volume of blood transfused). Core secondary outcomes included: overall survival and disease-free survival, transfusion-related complications, length of hospital stay, and hospitalization costs. Data from transplant and resection studies were analyzed separately. Random effects models were used for meta-analysis.

Results: 

Twenty-one observational studies were included (16 transplant, 5 resection, n=3433 patients). Seventeen studies incorporated oncologic indications. In transplant, IBSA was associated with decreased allogeneic RBC transfusion [mean difference –1.81, 95% confidence interval (−3.22, −0.40), P=0.01, I²=86%, very-low certainty]. Few resection studies reported on transfusion for meta-analysis. No significant difference existed in overall survival or disease-free survival in liver transplant [hazard ratio (HR)=1.12 (0.75, 1.68), P=0.59, I²=0%; HR=0.93 (0.57, 1.48), P=0.75, I²=0%] and liver resection [HR=0.69 (0.45, 1.05), P=0.08, I²=0%; HR=0.93 (0.59, 1.45), P=0.74, I²=0%].

Conclusion: 

IBSA may reduce intraoperative allogeneic RBC transfusion without compromising oncologic outcomes. The current evidence base is limited in size and quality, and high-quality randomized controlled trials are needed.

中文翻译：

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细胞回收应该用于肝切除和移植吗？系统回顾和荟萃分析

客观的： 

评估术中血细胞回收和自体输血（IBSA）的使用对肝脏手术中红细胞（RBC）输注和术后结果的影响。

背景： 

术中红细胞输注在肝脏手术中很常见，并且与发病率增加相关。IBSA 可用于最大限度地减少同种异体输血。癌症传播的理论上的风险限制了 IBSA 在肿瘤手术中的采用。

方法： 

电子数据库的检索时间从开始到 2021 年 5 月。所有比较 IBSA 在肝脏手术中的使用与对照的研究均被纳入。筛选、数据提取和偏倚风险评估均独立进行，一式两份。主要结局是术中同种异体红细胞输注（患者比例和输血量）。核心次要结局包括：总生存期和无病生存期、输血相关并发症、住院时间和住院费用。分别分析移植和切除研究的数据。使用随机效应模型进行荟萃分析。

结果： 

纳入 21 项观察性研究（16 项移植，5 项切除，n=3433 名患者）。十七项研究纳入了肿瘤学适应症。在移植中，IBSA 与同种异体红细胞输注减少相关[平均差 –1.81，95% 置信区间 (-3.22，-0.40)，P =0.01，I ² =86%，确定性极低]。很少有切除研究报告输血进行荟萃分析。肝移植总生存率或无病生存率无显着差异[风险比(HR)=1.12(0.75,1.68), P =0.59,I ² =0%; HR=0.93（0.57，1.48），P =0.75，I ² =0%]和肝切除[HR=0.69（0.45，1.05），P =0.08，I ² =0%；HR=0.93（0.59，1.45），P =0.74，I ² =0%]。

结论： 

IBSA 可以减少术中同种异体红细胞输注，而不影响肿瘤学结果。目前的证据基础在规模和质量上都有限，需要高质量的随机对照试验。