S178 INTRODUCTION: The cumulative immunosuppressive effects of allogeneic transfusions have been well documented, thus the limitation of their use in patients with malignancies has been advocated. [1,2] The utilization of intraoperative cell salvage (ICS) during surgical procedures in patients with malignancies is controversial, as the potential for reintroduction of tumor cells into the patient exists. [3] We report our seven-year experience with using ICS to decrease patient exposure to allogeneic blood during gross-total resection and reconstruction procedures for primary and metastatic spinal tumors. METHODS: A retrospective review of the anesthesiologists' and surgeon's records of all patients underwent gross-total resection and reconstruction procedures for primary and metastatic spine tumors at a 1,200 bed tertiary care university medical center, between 1990 and 1996, was undertaken. Primary tumor sites and surgical procedures were noted. Intraoperative estimated blood loss (EBL), ICS data, allogeneic transfusion requirements and complications were recorded. Information regarding patient survival at <or=to1 year, <or=to2 years and > 2 years was sought. Data are presented as means +/- standard deviations. RESULTS: 98 patients underwent spinal surgery in which blood collected by the Haemonetics Cell Saver 4[registered sign] (Haemonetics Corp, Braintree, MA) was of sufficient quantity to be returned to the patient. A 20 micron filter (Baxter Healthcare, Roundlake, IL) was used during reinfusion of the ICS blood. Fourteen patients, who underwent 15 procedures, had primary tumors including chordoma (8), hemangioma (2), neurofibroma (2), and osteogenic sarcoma of the spine (2), while the major primary sites of metastatic tumors in 83 patients included: renal (15), hematologic (10), colorectal (7), breast (6) and gynecologic (6). Tumor resection, with or without spine instrumentation, occurred in the cervical spine (7), thoracic spine (52), lumbar spine (29) and sacrum (15). EBL for the procedures was 3004cc +/- 2629cc (range 400-16,000cc). Total ICS volume for all cases was 91,340cc, which equals 365.4 units of PRBCs reclaimed. Mean ICS volume of PRBCs was 932cc +/- 798cc (range 250-3,250cc) per case, while allogeneic RBC use was 4 units +/- 4.6 units (range 0-26 units). Of the patients with primary tumors 78.6% have >2 year survival, one succumbed to an intraoperative MI, another to postoperative complications from diabetes and sepsis, and one had <or=to2 year survival secondary to complications from his primary tumor. The majority of patients with metastatic disease underwent procedures because they had cord compression or spine instability, and hoped to achieve improved ambulation status and decreased pain. 25.3% of these patients have >2 year survival, 28.9% between 1 and 2 year survival and 43.4%<or=to1 year survival. DISCUSSION: The use of ICS for malignancies continues to be controversial. We employ a standard 20 micron filter during reinfusion rather than a 40 micron leukocyte depletion filter (LDF) during these procedures, because the severe limitation in reinfusion rate imposed by the LDF would negate the advantage of using ICS, rather than allogeneic blood, during periods of intraoperative hemorrhage. Our data reveal that the use of ICS during surgical procedures for patients with spinal malignancies has not affected long-term survival, while it has decreased their exposure to allogeneic blood. Malignancy should not be an absolute contraindication to the use of ICS; decisions regarding its use should be made after a careful consideration of the risks and benefits.