Cancer surgery patients are among those most at high risk of perioperative anemia. Allogeneic transfusions are linked to adverse effects, including increased cancer recurrence and mortality. Intraoperative cell salvage (IOCS) offers a potential alternative, supported by recent observation studies and guidelines. However a largescale prospective randomized controlled trials (RCT) is still needed for definitive evidence. To assess the feasibility of such a trial in the French cancer center network, it is crucial to analyze the caseload of eligible surgeries.

Retrospective collection of data on surgical procedures and intraoperative transfusions in a cancer center in 2021. Possible uses of IOCS in 2021 were simulated according to pre-established criteria: 1) Transfusion within 10 days; 2) No potential for contamination of aspirated blood during surgery; 3) Blood loss > 500 mL.

At our cancer center, among 5808 procedures, 282 led to a transfusion and 65 surgeries were identified as eligible for IOCS, which could reduce transfusion requirements for those by 52 %.

The potential caseload of IOCS eligible surgeries makes this technology applicable in medium sized cancer centers. A multicenter randomized controlled trial (RCT) comparing IOCS to no IOCS in cancer surgery is feasible and warranted to evaluate its impact on transfusion rates and cancer outcomes.