A. S. Thomas1, N. Goel2, W. Kwon1, K. Sughahara1, B. Schrope1, J. Chabot1, M. D. Kluger1 1Columbia University Irving Medical Center,Department Of Surgery,New York, NY, USA 2University Of Miami,Sylvester Comprehensive Cancer Center, Division Of Surgical Oncology, Department Of Surgery,Miami, FL, USA
Introduction:
Allogeneic transfusions are expensive and have been shown to increase perioperative morbidity and mortality, and decrease recurrence-free and overall survival. Operative blood loss can be cell-salvaged for immediate transfusion by recovery devices. Despite transfusion rates during pancreatic surgery as high as 75%, these devices are not used during pancreatic cancer surgery due to a belief that this will seed distant metastases. Though intuitively reasonable, this belief is belied by our modern understanding of metastasis biology. This study is the first to compare PDAC CTCs in the systemic circulation prior to surgery, at the time of surgery, and in cell-salvaged filtered blood collected to evaluate whether recovered blood contains a greater concentration of CTCs.
Methods:
We conducted a prospective study of 50 patients with PDAC who underwent a pancreas resection at a high-volume academic center. Demographic, clinical, treatment, surgery type, estimated blood loss (EBL), intra-operative and post-operative transfusion data were collected. Pre-operative systemic, intra-operative systemic, and cell salvaged filtered blood was collected to evaluate CTCs using GEDI-captured PDAC-specific nucleated cells. Salvaged intraoperative blood was filtered through either a leukodepletion filter or a 40µm microaggregate filter. Wilcoxon matched-pairs signed-ranks test was used to compare CTCs in pre-operative systemic, intra-operative systemic, and cell-salvaged filtered blood.
Results:
Median age was 67.5 years and 29 (58%) were male. Thirty-two (64%) had borderline or locally advanced disease. Twenty-six (52%) received neoadjuvant treatment. Thirty-one (63%) had a preoperative biliary stent placed. Forty-three (89%) had a pancreaticoduodenectomy and venous reconstruction was performed in 16 (32%) patients. On final pathology 2% were T1, 26% were T2, 52% were T3, and 16% were T4. Thirty-six (18%) had N1 disease and 32 (16%) had N2 disease. The median EBL was 1000ml, 32% were transfused POD0, and 13 had transfusions POD1-7. There was no significant difference in the number of CTCs from systemic-intraoperative blood (p=0.5) or from cell-salvaged filtered blood (p=0.665) vs. pre-operative systemic blood.
Conclusion:
This prospective study is the first to objectively evaluate and compare the number of CTCs in systemic pre-operative, systemic intra-operative, and cell-salvaged filtered blood. Given no significant difference in the number of CTCs, this study serves as a foundation to consider autologous transfusion during PDAC surgery given the deleterious effects of allogeneic transfusions. Further study is warranted.
