INTRAOPERATIVE CELL SALVAGE DURING RADICAL PROSTATECTOMY IS NOT ASSOCIATED WITH GREATER BIOCHEMICAL RECURRENCE RATE ALAN M. NIEDER, ADRIENNE J. K. CARMACK, PAUL D. SVED, SANDY S. KIM, MURUGESAN MANOHARAN, AND MARK S. SOLOWAY ABSTRACT Objectives. To evaluate the risk of long-term biochemical recurrence for patients who receive cell-salvaged blood. Radical retropubic prostatectomy (RRP) is historically associated with the potential for significant blood loss. Different blood management strategies include blood donation, hemodilution, preoperative erythropoietin, and intraoperative cell salvage (IOCS). Oncologic surgeons have been reluctant to use IOCS because of the potential risk of tumor dissemination. Methods. We retrospectively analyzed an RRP database and compared those who did and did not receive cell-salvaged blood by baseline parameters, pathologic outcomes, and biochemical recurrence. We also stratified our patients according to the risk of recurrence. Results. A total of 1038 patients underwent RRP between 1992 and 2003. Of these, 265 (25.5%) received cell-salvaged blood and 773 (74.5%) did not. The two groups had similar baseline characteristics. No differences were found between the two groups when compared by risk of seminal vesicle invasion or positive surgical margins. Those who received cell-salvaged blood had a lower risk of extraprostatic extension. The median follow-up for all patients was 40.2 months. The overall risk of biochemical recurrence at 5 years for those who did and did not receive cell-salvaged blood was 15% and 18%, respectively (P = 0.76). No significant differences were found in the risk of biochemical recurrence when patients were stratified according to low, intermediate, and high risk. Conclusions. IOCS is a safe and effective blood management strategy for patients undergoing RRP. The risk of biochemical recurrence was not increased for those who received cell-salvaged blood. Concerns about spreading tumor cells by way of IOCS would seem unwarranted. UROLOGY 65: 730–734, 2005. © 2005 Elsevier Inc. R adical retropubic prostatectomy (RRP) is an operation that may be associated with signifi- cant blood loss. Variability in anatomy, difficulty in controlling the dorsal venous complex, nerve sparing versus non-nerve sparing, obesity, and sur- geon experience may all affect the estimated blood loss (EBL). The mean EBL during RRP has been reported as up to 1800 mL in previous series. 1 Even in contemporary series, the EBL ranges from 770 mL 2 to 1575 mL. 3 Some patients may require blood transfusion, either allogeneic or autologous. Blood volume management is thus an important issue in the care of patients undergoing RRP. The different means of managing blood loss include preopera- tive donation of autologous blood, 4 preoperative recombinant erythropoietin injection, 5 intraopera- tive hemodilution, 6 and intraoperative cell salvage (IOCS). 7 IOCS is an attractive blood management strategy, because it is relatively inexpensive, obvi- ates a trip to the blood bank, and prevents the risks associated with allogeneic blood transfusion such as viral infection. The risk of contracting human immunodeficiency virus or hepatitis C virus from a blood transfusion has been estimated to be greater than 1 in 200,000 and 1 in 30,000, respectively. 8 Even though the risks are low, the consequences are potentially life-threatening. Many oncologic surgeons have been reluctant to use IOCS because of the theoretical risk of tumor From the Department of Urology, University of Miami School of Medicine, Miami, Florida Reprint requests: Mark S. Soloway, M.D., Department of Urol- ogy, University of Miami School of Medicine, P.O. Box 016960 (M814), Miami, FL 33101. E-mail: msoloway@med.miami.edu Submitted: August 5, 2004, accepted (with revisions): October 27, 2004 ADULT UROLOGY © 2005 ELSEVIER INC. 0090-4295/05/$30.00 730 ALL RIGHTS RESERVED doi:10.1016/j.urology.2004.10.062