Grant: Project Grant

Liver surgery offers the best chance of cure for many people with cancers that have spread to the liver or started there. However, these operations often involve significant blood loss, and many patients require transfusions of donated blood. While transfusions can be lifesaving, they are associated with important risks, are costly, and depend on a limited public blood supply. An alternative approach is called "cell salvage." During surgery, blood that would otherwise be lost is collected, cleaned in a specialized machine, and returned to the patient. This allows patients to receive their own blood instead of donated blood. Although this technique is widely used in other types of surgery and is known to reduce the need for transfusions, it is rarely used in cancer surgery because of concerns that the collected blood could contain cancer cells and potentially increase the risk of the cancer coming back. Current evidence on this question is limited and based on small or lower-quality studies. As a result, doctors and patients must make decisions without clear, reliable data. We are proposing a large Canadian clinical trial in 16 liver surgery centres to determine whether using cell salvage is as safe as usual care in terms of cancer outcomes, while reducing the need for donated blood. Patients who helped design this study told us they would prefer to receive their own blood if it is proven to be safe. This study will provide the first definitive evidence to guide practice. Its results have the potential to improve the safety of liver surgery, reduce pressure on the blood system, and influence cancer surgery care in Canada and internationally.