Abstract: Objective To systematically evaluate the effectiveness of intraoperative cell salvage (IOCS) in reducing allogeneic blood transfusion (ABT) requirements and its potential impact on postoperative complications and tumor recurrence in urological open surgery. Methods Databases including PubMed, EMbase, Cochrane Library, Web of Science, CNKI, and WanFang were searched from inception to March 2025 for cohort studies and randomized controlled trials on IOCS application in urological surgery. Two researchers independently screened literature, extracted data, and assessed bias risk. Meta-analyses were conducted using RevMan 5.3 and Stata 17.0. Results Sixteen cohort studies (2 551 patients) were included. Meta-analysis showed that IOCS significantly reduced ABT rates compared to the non-IOCS group [OR=0.37, 95%CI (0.14~0.98), P=0.04], but no significant difference was observed when compared to preoperative autologous donation [OR=0.66, 95%CI (0.35~1.24), P=0.20]. No significant difference was found in overall postoperative complications [OR=0.98, 95%CI (0.57~1.68), P=0.93]. The IOCS group exhibited a significantly lower tumor recurrence rate [OR=0.49, 95%CI (0.33~0.71), P=0.000 2], with a more pronounced effect in the prostatectomy subgroup [OR=0.37, 95%CI (0.23~0.61), P<0.000 1]. Conclusion IOCS effectively reduces ABT requirements in urological surgery without increasing short-term complications. Due to the heterogeneity of the included studies, the long-term oncological safety of IOCS still requires high-quality prospective research support.

Key words: Intraoperative cell salvage, Urological surgery, Allogeneic blood transfusion, Tumor recurrence, Meta-analysis