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Extracorporeal tumor cell filtration during extended liver surgery: first clinical use of leukocyte depletion filters--case series.

Oldhafer KJ, Stavrou GA, Donati M, Kaudel P, Frühauf NR - World J Surg Oncol (2013)

Bottom Line: In a first clinical attempt, leukocyte adhesion filters were integrated into veno-venous bypass systems in four patients undergoing extended liver surgery for secondary hepatic malignancies.Practicability, handling, and safety aspects as well as potency of cell removal and clinical side effects of the filter system were analyzed.Effectiveness of CK+ cell depletion and safety of the procedure was shown.The presented surgical technique represents a safe and innovative tool; however, clinical significance has to be examined in a larger patient cohort.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Rübenkamp 220, 22293 Hamburg, Germany. k.oldhafer@asklepios.com

ABSTRACT

Background: During oncologic surgery, intraoperative manipulation of tumor tissue is almost unpreventable and causes a high risk of tumor cell dissemination into venous blood. A tumor cell-reducing effect of leukocyte adhesion filter systems has been shown under in vitro conditions.

Methods: In a first clinical attempt, leukocyte adhesion filters were integrated into veno-venous bypass systems in four patients undergoing extended liver surgery for secondary hepatic malignancies.Practicability, handling, and safety aspects as well as potency of cell removal and clinical side effects of the filter system were analyzed.

Results: All patients tolerated the application of the system without problems during operative and postoperative follow-up. Immunohistochemical staining of perioperative blood samples detected cytokeratin positive (CK+) cells in three cases during the hepatic mobilization.

Conclusions: Effectiveness of CK+ cell depletion and safety of the procedure was shown. The presented surgical technique represents a safe and innovative tool; however, clinical significance has to be examined in a larger patient cohort.

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Related in: MedlinePlus

Schematic drawing of the extracorporeal veno-venous bypass circulation system. Portal, left femoral, and left subclavian veins are cannulated by flow catheters. A centrifugal bio pump system (BP80, BioMedicus©, Germany) is used (P). Filter cartouches (F) are integrated in parallel.
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Figure 1: Schematic drawing of the extracorporeal veno-venous bypass circulation system. Portal, left femoral, and left subclavian veins are cannulated by flow catheters. A centrifugal bio pump system (BP80, BioMedicus©, Germany) is used (P). Filter cartouches (F) are integrated in parallel.

Mentions: The extracorporeal bypass system was implemented by puncture of the left subclavian and left femoral vein using high-flow catheters (14 F, Medos©, Germany) in the Seldinger technique. After laparotomy and dissection of the hepatoduodenal ligament the portal vein was additionally cannulated [15]. Leukocyte filters were integrated into the bypass circuit. The tubing system was pre-coated with 10% albumin-solution. After system setup, the extracorporeal circulation was started following simultaneous clamping of the inferior cava vein beneath the diaphragm (Figure 1); the flow rate was kept between 0.9 and 2.5 L/min. During bypass circulation all patients received heparin within an activated clotting time target of >150 s. Each 30 minutes of filtration the filter cartridges were replaced. Once hepatic mobilization finished, leukocyte depletion filters were removed for the remaining bypass time (individually depending on the surgical procedure).


Extracorporeal tumor cell filtration during extended liver surgery: first clinical use of leukocyte depletion filters--case series.

Oldhafer KJ, Stavrou GA, Donati M, Kaudel P, Frühauf NR - World J Surg Oncol (2013)

Schematic drawing of the extracorporeal veno-venous bypass circulation system. Portal, left femoral, and left subclavian veins are cannulated by flow catheters. A centrifugal bio pump system (BP80, BioMedicus©, Germany) is used (P). Filter cartouches (F) are integrated in parallel.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3721985&req=5

Figure 1: Schematic drawing of the extracorporeal veno-venous bypass circulation system. Portal, left femoral, and left subclavian veins are cannulated by flow catheters. A centrifugal bio pump system (BP80, BioMedicus©, Germany) is used (P). Filter cartouches (F) are integrated in parallel.
Mentions: The extracorporeal bypass system was implemented by puncture of the left subclavian and left femoral vein using high-flow catheters (14 F, Medos©, Germany) in the Seldinger technique. After laparotomy and dissection of the hepatoduodenal ligament the portal vein was additionally cannulated [15]. Leukocyte filters were integrated into the bypass circuit. The tubing system was pre-coated with 10% albumin-solution. After system setup, the extracorporeal circulation was started following simultaneous clamping of the inferior cava vein beneath the diaphragm (Figure 1); the flow rate was kept between 0.9 and 2.5 L/min. During bypass circulation all patients received heparin within an activated clotting time target of >150 s. Each 30 minutes of filtration the filter cartridges were replaced. Once hepatic mobilization finished, leukocyte depletion filters were removed for the remaining bypass time (individually depending on the surgical procedure).

Bottom Line: In a first clinical attempt, leukocyte adhesion filters were integrated into veno-venous bypass systems in four patients undergoing extended liver surgery for secondary hepatic malignancies.Practicability, handling, and safety aspects as well as potency of cell removal and clinical side effects of the filter system were analyzed.Effectiveness of CK+ cell depletion and safety of the procedure was shown.The presented surgical technique represents a safe and innovative tool; however, clinical significance has to be examined in a larger patient cohort.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Rübenkamp 220, 22293 Hamburg, Germany. k.oldhafer@asklepios.com

ABSTRACT

Background: During oncologic surgery, intraoperative manipulation of tumor tissue is almost unpreventable and causes a high risk of tumor cell dissemination into venous blood. A tumor cell-reducing effect of leukocyte adhesion filter systems has been shown under in vitro conditions.

Methods: In a first clinical attempt, leukocyte adhesion filters were integrated into veno-venous bypass systems in four patients undergoing extended liver surgery for secondary hepatic malignancies.Practicability, handling, and safety aspects as well as potency of cell removal and clinical side effects of the filter system were analyzed.

Results: All patients tolerated the application of the system without problems during operative and postoperative follow-up. Immunohistochemical staining of perioperative blood samples detected cytokeratin positive (CK+) cells in three cases during the hepatic mobilization.

Conclusions: Effectiveness of CK+ cell depletion and safety of the procedure was shown. The presented surgical technique represents a safe and innovative tool; however, clinical significance has to be examined in a larger patient cohort.

Show MeSH
Related in: MedlinePlus