Impact of Intraoperative Cell Salvage on Circulating Tumor Cells and Cellular Activity in Patients with Hepatocellular Carcinoma Undergoing Curative Resection: A Prospective Comparative Study

Abstract

This study investigates the effects of intraoperative cell salvage (IOCS) on cell survival rates, apoptosis levels, and circulating tumor cell (CTC) counts in patients with hepatocellular carcinoma (HCC) undergoing curative resection. A combination of immunofluorescence, Western blot, flow cytometry, and qRT-PCR was employed to assess the impact of IOCS on cellular activity and CTC dynamics in these patients. No significant differences were found in demographic characteristics, including gender, age, body mass index (BMI), Child-Pugh classification, and liver function markers (alanine aminotransferase [ALT] and aspartate aminotransferase [AST]) between the experimental and control groups. Preoperatively, both groups exhibited low cell survival rates without statistical differences (P > 0.05), and cell survival remained similarly low during surgery. However, 6 h post-surgery, the experimental group showed a significant increase in cell survival rates compared with the control group (P < 0.05), suggesting that IOCS enhances postoperative cell viability. Apoptosis levels were similarly high in both groups before and during surgery (P > 0.05), but notably, 6 h post-operation, apoptosis levels in the experimental group were significantly reduced (P < 0.05), indicating effective prevention of cell death. Although preoperative CTC counts were low and increased during surgery, no significant differences were observed between groups during surgery. However, 6 h post-surgery, the experimental group exhibited a marked decrease in CTC counts (P < 0.05), indicating a reduction in tumor cell dissemination. Although these findings suggest that IOCS improves cell survival and reduces apoptosis and CTC counts, there is a potential concern regarding the possibility of IOCS preferentially preserving viable cells with metastatic potential. The long-term impact of this intervention on tumor recurrence or metastasis requires further investigation. In conclusion, IOCS appears to offer short-term benefits in enhancing postoperative cell survival and reducing CTC dissemination in patients with HCC; however, the potential risk of promoting metastatic cell viability warrants additional study before broader clinical application.

Keywords: Cellular activity; Circulating tumor cell; Hepatocellular carcinoma; Intraoperative cell salvage.