# The Trial of Intraoperative Cell Salvage Versus Transfusion in Ovarian Cancer (TIC TOC): Results of a Randomized Controlled Feasibility Study

## TL;DR

This study found that using a patient's own blood during ovarian cancer surgery is feasible and acceptable, suggesting it could reduce the need for donor blood.

## Contribution

The study demonstrates the feasibility and patient acceptance of intraoperative cell salvage in ovarian cancer surgery for the first time.

## Key findings

- Intraoperative cell salvage was used successfully in 62% of surgeries in the ICS group.
- Women were comfortable with the idea of receiving their own salvaged blood.
- Recruitment and follow-up rates were sufficient for planning a larger trial.

## Abstract

This study looked at whether it is acceptable to use intraoperative cell salvage (ICS) during surgery for women with advanced (stage 3–4) ovarian cancer. ICS is a method that collects a patient’s own blood lost during surgery, cleans it, and gives it back to them, reducing the need for donated blood. A total of 57 women with ovarian cancer took part; the amount of blood loss during surgery was similar in both groups. In the ICS group, about two-thirds of the women who had surgery received their own salvaged blood. Women appeared comfortable with the idea of receiving their own salvaged blood. Overall, this study shows that using ICS in ovarian cancer surgery is both feasible and acceptable to patients. The findings suggest that a larger trial should now be carried out to determine whether ICS can reduce the need for donor blood and improve patient outcomes.

Objectives: To evaluate the acceptability and feasibility of intraoperative cell salvage (ICS) in women with ovarian cancer. A prospective multicenter randomized controlled feasibility trial. Setting: Four U.K. cancer centers. Women FIGO stage III/IV ovarian cancer supported by CT scan evidence. We randomized women to receive ICS or donor blood (as required) during surgery for ovarian cancer. The acceptability and feasibility of ICS in women with ovarian cancer having cytoreductive surgery; rates of recruitment for a larger trial and the likely completeness of resource use and outcome data; and blinding of allocation for participants and outcome assessors. A total of 57 women were included; the rate of recruitment was 1.4 cases per month, which closely aligns with the target, and 66% of the eligible patients were recruited. Overall, 91% of women completed the 30-day follow-up, and 75% completed the six-week follow-up. Mean (SD) blood loss in the ICS group was 1022 mL (SD 929 mL) and 924 mL (SD 646 mL) in the control group. A total of 16 (62%) of the participants undergoing surgery in the ICS arm received ICS reinfusion. Of the ten participants in the intervention group who did not receive ICS, six participants lost a significant volume of blood requiring transfusion. In the donor blood group, 14 of the 29 participants received donor blood. In the ICS group, 20/24 (83%) of participants, and 23/24 (96%) of research nurses did not know their group allocation. In the control group, 24/28 (86%) and 25/29 (86%) of participants and research nurses did not know the group allocation. Our study provides clinical evidence of the feasibility and acceptability of using ICS in ovarian cancer surgery and provides useful insights into the use of ICS within clinical trials. Women are open to having ICS as an alternative to blood transfusion. An appropriately powered randomized controlled trial is now required.