Surgeon Perspectives on Intraoperative Cell Salvage in Liver Resection for Cancer: A National Survey of Hepatopancreatobiliary Surgeons.

BACKGROUND: Intraoperative cell salvage reduces exposure to allogeneic blood transfusion during major surgery. However, its use in liver resection for cancer remains limited due to concerns regarding tumor-cell dissemination and oncologic safety. The extent to which these concerns influence surgical practice is not well characterized. METHODS: We conducted a national cross-sectional survey of Canadian hepatopancreatobiliary surgeons to assess familiarity, use, and perceptions of IOCS during liver resection for cancer. The anonymous electronic survey was distributed through national HPB networks. Descriptive statistics summarized responses. RESULTS: Twenty-six HPB surgeons representing 18 Canadian liver surgery programs responded. Most reported moderate/high familiarity with IOCS (23/26) and occasional use in practice (23/26) but use during liver resection for cancer was lower (10/26). Concerns regarding tumor cell contamination were the most frequently cited barrier (13/26). Long-term oncologic outcome data was the factor most commonly identified as increasing confidence in IOCS use (20/26). Most respondents indicated willingness to participate in a clinical trial evaluating oncologic safety (22/26), and all supported guideline incorporation if safety were demonstrated. CONCLUSIONS: Despite high familiarity with IOCS, adoption in liver cancer surgery remains limited due to concerns regarding oncologic safety. These findings highlight ongoing clinical equipoise and support the need for high-quality outcome data to guide adoption.