Reduction of cancer cell quantity and viability in autologous blood salvaged from patients with liver cancer: efficacy of intraoperative cell salvage coupled with leukocyte depletion filtration

OBJECTIVE: This in vitro study aims to evaluate the effects of intraoperative cell salvage (ICS) combined with leukocyte depletion filtration (LDF) on hepatocellular carcinoma (HCC) cell number and viability in salvaged autologous blood from patients undergoing liver cancer surgery. METHODS: Twenty patients undergoing open radical resection for primary liver cancer with ICS were enrolled in the study.Blood samples of 20 ml each were procured at three distinct stages: from the surgical field(S1),post ICS treatment(S2),and post ICS treatment combined with leukocyte depletion filter(LDF) filtration(S3).Within these 20-ml blood samples,10 ml underwent cancer cell enrichment procedures, followed by identification and enumeration of cancer cells using immunofluorescence staining.The remaining 10 ml of blood samples were cultured for a duration of three weeks, with subsequent assessment of cell viability using immunofluorescence techniques subsequent to enrichment procedures. RESULTS: HCC cells were identified in samples obtained from S1(19/20),S2(18/20),and S3 (16/20) without a significant difference in the detection rate(P > 0.05).However, a significant reduction in HCC cells count was observed in samples from S2 and S3 when compared to S1(P < 0.05). Notably, no statistically significant differences were noted between HCC cells counts in samples from S2 and S3(P > 0.05). Following three weeks of culture, optical microscopy revealed the presence of liver cancer cell clusters exclusively in S1 samples, while such clusters were absent in samples from S2 and S3. Further examination under fluorescence microscopy indicated the presence of epithelial-mesenchymal hybrid-type HCC cells(S1: 400, S2: 14) and mesenchymal-type HCC cells(S1: 100, S2: 21) in both S1 and S2 samples, whereas no HCC cells were detected in S3 samples.Specifically, HCC cells in S1 samples manifested as liver cancer cell clusters, whereas such clusters were notably absent in samples from S2 and S3. CONCLUSION: Following treatment with ICS alone or in combination with LDF (ICS-LDF), both the number and viability of hepatocellular carcinoma (HCC) cells in salvaged autologous blood were markedly decreased, with no cell cluster formation, which lowered the risk of salvaging cancer cells to some extent. Nevertheless, LDF failed to completely remove HCC cells from all samples, and its filtration efficiency may be compromised when the HCC cell number exceeds a certain threshold.