The Association Between Intraoperative Cell Salvage and Tumor Recurrence in Patients Undergoing Meningioma Resection: An Observational Study

BACKGROUND: The oncologic safety of intraoperative cell salvage (ICS) during meningioma surgery remains controversial due to concerns about hematogenous tumor dissemination. We investigated the association between ICS use and postoperative tumor recurrence in patients undergoing meningioma resection. METHODS: This study retrospectively included adult patients who underwent meningioma resection with intraoperative blood loss >1000 mL at Beijing Tiantan Hospital between August 2015 and November 2022. The primary outcome was postoperative tumor recurrence. Propensity scores were estimated using clinically relevant baseline variables, and inverse probability of treatment weighting with stabilized weights was applied to reduce confounding. RESULTS: Among 988 patients, 89 (9.0%) developed recurrence during a mean follow-up of 60 months. Recurrence was less frequent in patients receiving ICS than in those without ICS (7.9% vs. 14.9%, P=0.004). After inverse probability of treatment weighting adjustment, baseline characteristics were well balanced between groups. In the weighted Cox model, ICS use was not associated with increased recurrence risk (HR=0.62, 95% CI: 0.39-0.99, P=0.043). Higher WHO grade was independently associated with increased recurrence risk, whereas gross total resection was associated with reduced risk. Sensitivity analyses yielded consistent results. CONCLUSION: In patients undergoing meningioma surgery with substantial intraoperative blood loss, intraoperative cell salvage was not associated with an increased risk of tumor recurrence.