Oncologic outcomes following radical prostatectomy with intraoperative cell salvage

Purpose: To evaluate oncologic outcomes following the use of intraoperative cell salvage (IOCS) as a blood loss management strategy during open radical prostatectomy (RP). Methods: We retrospectively reviewed all open retropubic RP cases performed by a single surgeon. Patients were identified who received IOCS blood and evaluated for an increased risk of biochemical recurrence (BCR) and overall mortality. Results: The study cohort consisted of 1,862 men, 395 (21.2%) of whom received IOCS blood. At a median follow-up of 47.0 months, men who received IOCS blood were not at an increased risk of BCR (P = 0.323) or all-cause mortality (P = 0.892). IOCS use did not confer an increased risk of BCR within any D'Amico preoperative risk category (low risk, P = 0.592; intermediate risk, P = 0.107; and high risk, P = 0.697). Conclusions: IOCS is safe for the management of blood loss during RP. At long-term follow-up, IOCS use was not associated with an increased risk of BCR or death. While it remains preferable to avoid any form of blood transfusion, we advocate for the use of IOCS in place of allogeneic blood. These conclusions are drawn from our study of the largest and longest followed cohort patients who received IOCS blood during RP.