Introduction: The use of autologous blood transfusions in oncologic surgeries is somewhat controversial due to the potential risk of disease dissemination through the salvage process. On the other hand, autologous blood transfusion can prevent the potential negative effects of allogenic blood transfusions and reduce use of valuable resources. Methods: This study included 106 adult patients who underwent oncologic liver surgery at our institution between December 2015 and June 2019. The patients were divided into two groups: the Cell Saver group (operated between January 2018 and June 2019) and the control group (operated between December 2015 and December 2017). The Cell Saver device was present in the operating room for the Cell Saver group, and blood was retransfused if a certain amount of blood loss occurred. Data analysis focused on outcomes such as blood transfusion requirements, overall survival, recurrence-free survival, hemoglobin levels, hospital stay, and complications. Patient records provided relevant information on demographics, surgery details, pathology, and outcomes for both groups. Results: Autologous blood transfusion was found to reduce the amount of blood units needed (4.0 units (control group) versus 0.4 units (Cell Saver group) P=0.029. Kaplan–Meier curves showed no difference for both overall survival 471.6 days (Cell Saver group) versus 468.3 days (control group) (P=0.219) and 488.9 days (Cell Saver group) versus 487.2 days (control group) (P=0.993) and disease-free survival (P=0.553) and (P=0.735) for primary hepatic tumors and hepatic metastasis respectively between the Cell Saver and control groups. Overall survival regardless of the type of tumor was similar to the control group (485.4 days vs. 481.9 days) (P=0.503). Survival was significantly lower for minor hepatectomies (516.0 days vs. 517.4 days) (P=0.050) in the Cell Saver group, major hepatectomies showed no difference in overall survival (470.2 days vs. 466.4 days) (P=0.868). No impact on disease recurrence was found between patients who received autologous blood transfusions versus those who did not. Conclusion: The use of Cell Saver should not be avoided in oncologic surgeries of the liver. Use of Cell Saver for major hepatectomies might be more beneficial as OS was significantly lower for the Cell Saver group for patients who underwent minor hepactomies. Further research is needed to explain this conflicting result. Nonetheless, the use of Cell Saver in autologous blood transfusions can reduce the use of valuable resources and the risks associated with allogenic blood transfusions.

Background: Surgical resection is the most efficient treatment for isolated colorectal cancer hepatic metastases. Among the known prognostic factors of this procedure, the impact of the resection margin width is still a controversial matter in the literature. Methods: A retrospective cohort study was performed including 170 patients who underwent surgical resection of colorectal cancer liver metastases (CRLMs) between 2006 and 2016 in our hepatobiliary unit. Resection margin width was determined histologically by measuring the distance from the tumour in millimetres or centimetres. Patients’ clinical characteristics were also collected. Patients were then stratified in two tumour margin groups: below 5 mm (group A) and equal to or above 5 mm (group B). Overall survival (OS) and disease-free survival (DFS) were the primary outcomes. Results: Kaplan–Meier curves showed significantly better outcomes for cases having resection margins above 5 mm for both DFS with 1508.7 days (range 1151.2–1866.2) in group A, compared to 2463.9 days (range 2021.3–2906.5) in group B (P=0.049), and OS with 1557.8 days (range 1276.3–1839.3) for group A and 2303.8 days (range 1921.2–-2686.4) for group B (P=0.020). This survival benefit was not significant for patients presenting with stage IV CRC at diagnosis or cases where extended (7+ segments) resections were performed. Conclusion: Five-millimetre margins provide a significant survival advantage and should be aimed for in the treatment of CRLMs. Further research on the cause for this finding, including tumour biology’s impact on survival, is required.

Introduction: Spinal surgery involves different techniques and treatment strategies. Intraoperative navigation by 3D tomography (IoCT) is used to facilitate the insertion of pedicular screws. Better accuracy has been demonstrated by several studies when using navigation compared to fluoroscopy. However, no study as far as we know, investigated the operative outcomes of navigation during single-level transforaminal interbody fusion (SL-TLIF). Objectives: Our goal was to evaluate the impact of Computer Assisted Navigation during SL-TLIF in terms of operative time, hospitalization, blood loss and number of surgical revisions up to 6 months postoperatively when compared to fluoroscopic guidance. Methods: This is a retrospective, single center, case-control study. Patients submitted to SL-TLIF between 2016 and 2020 with fluoroscopy (Fluoro) or loCT navigation (Nav) were evaluated. We excluded traumatic, oncological, infectious, minimally invasive cases, anterior and lateral cases and all those performed on more than one level. Demographic, clinical, and surgical data were collected. Results: One hundred and seventy-six patients were included, 54 (30.68%) in the Nav group and 122 (69.32%) in the Fluoro group. A statistically significant difference in operative time (OT) was reported (Nav 185.93 Vs. Fluoro 163.24, p=0.003), with an average OT of 170 min. The revision rate was also significantly different, with 8 revisions of surgery in the Fluoro group and none in the Nav group (6.6% of GF patients, p=0.050). No statistically significant difference was found for blood loss (Nav 270.83 ml vs. Fluoro 277.28 ml p=0.827) and hospitalization time (days) (4.31 for Nav vs. 4.65 for Fluoro p=0.302). Discussion: Despite the increase in operative time in the Nav group, navigation does not involve increased blood loss or longer hospital stay. We observed a lower rate of reoperation in the Nav group during the first 6 months postoperatively. Conclusions: The use of IoCT navigation is safe, effective, and provides advantages even when used to perform single level TLIF.